Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 25MA10103600 | NJ |
NPI | 1699119198 |
---|---|
Provider Name | Laura Dhariwal |
First Address | Boston, MA 02241-6457 |
Second Address | Summit, NJ 07901-3564 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2013 |
Last Update Date | 03/08/2020 |