Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DI02074900 | NJ |
NPI | 1588607311 |
---|---|
Provider Name | Mrs. Ninoska Fergusson |
First Address | Township Of Washington, NJ 07676-4503 |
Second Address | West New York, NJ 07093-2622 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 13/03/2012 |