Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DI19783 | NJ |
NPI | 1063457356 |
---|---|
Provider Name | Mara L Leveson |
First Address | Skillman, NJ 08558-2248 |
Second Address | Princeton, NJ 08540-2757 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2006 |
Last Update Date | 08/07/2007 |