Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 31TD00169700 | NJ |
NPI | 1194932780 |
---|---|
Provider Name | Mrs. Silfa N Cruz |
First Address | Perth Amboy, NJ 08861-4315 |
Second Address | Perth Amboy, NJ 08861-4315 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3286606 | (05) | NJ |