Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 40QA01438700 | NJ |
NPI | 1023641859 |
---|---|
Provider Name | Jennifer Watt |
First Address | Lawrenceville, NJ 08648-3757 |
Second Address | Mercerville, NJ 08619-1658 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2020 |
Last Update Date | 20/02/2020 |