Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 2183 | TX |
Y | 222Z00000X | Podiatrist | 2183 | TX |
NPI | 1023430121 |
---|---|
Provider Name | Jennifer Maungu |
First Address | Brooklyn, NY 11237-4006 |
Second Address | Brooklyn, NY 11237-4006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2014 |
Last Update Date | 27/08/2015 |