Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 26NJ00968900 | NJ |
NPI | 1003454158 |
---|---|
Provider Name | Mrs. Nina Manesh Villalobos |
First Address | Green Village, NJ 07935-3016 |
Second Address | Morristown, NJ 07960-6996 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2019 |
Last Update Date | 18/12/2019 |