Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | 3935830001 | NJ |
NPI | 1427136423 |
---|---|
Provider Name | Mrs. Narisa Pongklang |
First Address | Parsippany, NJ 07054 |
Second Address | Parsippany, NJ 07054 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 15/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3935830001 | (02) |