Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 26NJ00042500 | NJ |
NPI | 1003974858 |
---|---|
Provider Name | Ms. Erica B Gopalan |
First Address | Delran, NJ 08075-2521 |
Second Address | Delran, NJ 08075-2521 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 08/07/2007 |