Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 40QA00608000 | NJ |
NPI | 1174936413 |
---|---|
Provider Name | Mrs. Doreen Stellke Levine |
First Address | Mendham, NJ 07945-2021 |
Second Address | Mendham, NJ 07945-2021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2014 |
Last Update Date | 04/06/2014 |