Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 25MA09307500 | NJ |
NPI | 1992938765 |
---|---|
Provider Name | Mukta Bansal |
First Address | Voorhees, NJ 08043-9573 |
Second Address | Voorhees, NJ 08043-9573 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2009 |
Last Update Date | 09/02/2014 |