Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | MA034163 | NJ |
NPI | 1053486662 |
---|---|
Provider Name | Marie Trontell |
First Address | New Brunswick, NJ 08901-2008 |
Second Address | New Brunswick, NJ 08901-1962 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 23/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1652800 | (05) | NJ |
C58018 | (02) | NJ |