Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | 31TD00373000 | NJ |
NPI | 1306130638 |
---|---|
Provider Name | Ms. Karina Manukyan |
First Address | New Brunswick, NJ 08901-2276 |
Second Address | New Brunswick, NJ 08901-2276 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2011 |
Last Update Date | 03/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0165441 | (05) | NJ |