Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 25MA07783600 | NJ |
NPI | 1003886516 |
---|---|
Provider Name | Miss Eliezer Aurelina Mordan |
First Address | Parlin, NJ 08859-3179 |
Second Address | Perth Amboy, NJ 08861-3674 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 29/04/2008 |