Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 18KT00649900 | NJ |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 18KT00649900 | NJ |
N | 2081P2900X | Pain Medicine | 18KT00649900 | NJ |
NPI | 1295246510 |
---|---|
Provider Name | Faith Essence Smash |
First Address | Northvale, NJ 07647-2028 |
Second Address | Northvale, NJ 07647-2028 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2017 |
Last Update Date | 12/10/2017 |