Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 25MA06170600 | NJ |
NPI | 1003988403 |
---|---|
Provider Name | Mrs. Jonel M Dershem |
First Address | Voorhees, NJ 08043-0598 |
Second Address | Voorhees, NJ 08043-4501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 22/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G20808 | (02) |