Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 1581946 | NJ |
NPI | 1134761349 |
---|---|
Provider Name | Rita Sanders |
First Address | Jersey City, NJ 07302-3458 |
Second Address | Jersey City, NJ 07302-3458 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2019 |
Last Update Date | 09/10/2019 |