Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 25MA08481100 | NJ |
Y | 208600000X | Surgeon | 25MA08481100 | NJ |
NPI | 1013162858 |
---|---|
Provider Name | Martine Mariealice Louis |
First Address | Valley Stream, NY 11580-2832 |
Second Address | Union, NJ 07083-6634 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2008 |
Last Update Date | 20/11/2008 |