Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 25MA09496800 | NJ |
NPI | 1932365400 |
---|---|
Provider Name | Joann Carlson |
First Address | New Brunswick, NJ 08901-1935 |
Second Address | New Brunswick, NJ 08901-1935 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2008 |
Last Update Date | 19/09/2014 |