Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223E0200X | Endodontist | 043598-1 | NY |
Y | 1223E0200X | Endodontist | DI17888 | NJ |
NPI | 1063512333 |
---|---|
Provider Name | Mrs. Maya Prabhu |
First Address | Plainsboro, NJ 08536-3137 |
Second Address | New Brunswick, NJ 08901-2520 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 19/07/2012 |