Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | QA00873100 | NJ |
Y | 213ES0000X | Sports Medicine | QA00873100 | NJ |
NPI | 1013085315 |
---|---|
Provider Name | Ms. Jennifer K Soares |
First Address | Franklin Lakes, NJ 07417-1368 |
Second Address | Franklin Lakes, NJ 07417-1368 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 26/11/2012 |