Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | PTQA01102400 | NJ |
NPI | 1306081716 |
---|---|
Provider Name | Leilani Malibiran |
First Address | Passaic, NJ 07055-3725 |
Second Address | Bayonne, NJ 07002-3800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2008 |
Last Update Date | 15/12/2008 |