Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 26NJ00884800 | NJ |
NPI | 1306317094 |
---|---|
Provider Name | Mrs. Samira Razzaq |
First Address | Bayonne, NJ 07002-4345 |
Second Address | Bayonne, NJ 07002-3623 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2018 |
Last Update Date | 06/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
26NJ00884800 | REGISTERED NURSE PRACTITIONER (01) | NJ |