Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 25MP00658200 | NJ |
NPI | 1407513369 |
---|---|
Provider Name | Jade Hawkins |
First Address | Wood Ridge, NJ 07075-2444 |
Second Address | Paramus, NJ 07652 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2021 |
Last Update Date | 26/11/2021 |