Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 46TR00717200 | NJ |
NPI | 1285227744 |
---|---|
Provider Name | Jenn Chung |
First Address | Palisades Park, NJ 07650-1009 |
Second Address | Newark, NJ 07103-2425 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2021 |
Last Update Date | 16/02/2021 |