Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 45OR00003100 | NJ |
Y | 222Z00000X | Podiatrist | 45OR00003100 | NJ |
N | 224P00000X | Prosthetist | 45PR00003500 | NJ |
NPI | 1033473715 |
---|---|
Provider Name | Ms. Brooke Artesi |
First Address | Kinnelon, NJ 07405-3013 |
Second Address | Wayne, NJ 07470-7536 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2012 |
Last Update Date | 27/06/2012 |