Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 25MA08313200 | NJ |
NPI | 1023292307 |
---|---|
Provider Name | Jodi Komoroski Sebastian |
First Address | Boston, MA 02241-6457 |
Second Address | Cedar Knolls, NJ 07927-1902 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2007 |
Last Update Date | 02/12/2016 |