Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 31TD00383500 | NJ |
NPI | 1033599584 |
---|---|
Provider Name | Jamie Sharon |
First Address | Runnemede, NJ 08078-1455 |
Second Address | Runnemede, NJ 08078-1455 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2015 |
Last Update Date | 30/05/2015 |