Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | MA60634 | NJ |
NPI | 1043371966 |
---|---|
Provider Name | Jacqueline Angela Williams-Phillips |
First Address | New Brunswick, NJ 08901-1928 |
Second Address | New Brunswick, NJ 08901-1928 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 13/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6222307 | (05) | NJ |
F52897 | (02) | NJ |