Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 25MA04189100 | NJ |
NPI | 1013963032 |
---|---|
Provider Name | Prof. Christopha Honorata Rozdeba |
First Address | Wallington, NJ 07057-1300 |
Second Address | Wallington, NJ 07057-1300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 08/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1398504 | (05) | NJ |
C52405 | (02) | NJ |