Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 25MA09531800 | NJ |
N | 111NI0900X | Internist | 25MA09531800 | NJ |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 25MA09531800 | NJ |
NPI | 1003238817 |
---|---|
Provider Name | Lissette Maria Cespedes |
First Address | Union, NJ 07083-5405 |
Second Address | Newark, NJ 07103-2757 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2014 |
Last Update Date | 02/05/2017 |