Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 46TR00224200 | NJ |
NPI | 1053736462 |
---|---|
Provider Name | Ms. Stephanie Lubalin |
First Address | Hoboken, NJ 07030-5599 |
Second Address | Hoboken, NJ 07030-5599 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2014 |
Last Update Date | 21/02/2014 |