Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 40QA01435600 | NJ |
NPI | 1487097259 |
---|---|
Provider Name | Justine Mamone |
First Address | Rutherford, NJ 07070-1150 |
Second Address | West Orange, NJ 07052-1424 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2013 |
Last Update Date | 11/04/2013 |