Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 40QA00512200 | NJ |
NPI | 1043825136 |
---|---|
Provider Name | Ma Elisa Capiton Senupe |
First Address | Toms River, NJ 08757-4036 |
Second Address | Toms River, NJ 08757 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2020 |
Last Update Date | 15/09/2020 |