Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0200X | Nurse Practitioner - Pediatrics | 26NR14057000 | NJ |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | F382250-1 | NY |
NPI | 1023369741 |
---|---|
Provider Name | Mrs. Clarissa Barbon Vogel |
First Address | Fair Lawn, NJ 07410-7300 |
Second Address | New York, NY 10032-1559 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2012 |
Last Update Date | 08/07/2016 |