Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 25MA06413000 | NJ |
NPI | 1023017357 |
---|---|
Provider Name | Lauren A Kallina |
First Address | Bloomfield, NJ 07003-3003 |
Second Address | Bloomfield, NJ 07003-3000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 30/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7161204 | (05) | NJ |