Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 25MA03743600 | NJ |
NPI | 1417031873 |
---|---|
Provider Name | Kathleen Thomas |
First Address | Kearny, NJ 07032 |
Second Address | Kearny, NJ 07032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3864103 | (05) | NJ |
E13945 | (02) |