Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 37420 | NJ |
NPI | 1043319155 |
---|---|
Provider Name | Ferne R Lavine |
First Address | New Brunswick, NJ 08901-1608 |
Second Address | Edison, NJ 08820-1082 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 07/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C53110 | (02) |