Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | NJ |
NPI | 1043231574 |
---|---|
Provider Name | Ms. Ed Nelvyn Lezette Evans |
First Address | Teaneck, NJ 07666-6234 |
Second Address | Hackensack, NJ 07601-2570 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 08/07/2007 |