Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 382612 | NY |
NPI | 1003290420 |
---|---|
Provider Name | Samantha Goldklang |
First Address | Wood-Ridge, NJ 07075 |
Second Address | Wood-Ridge, NJ 07075 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2015 |
Last Update Date | 04/05/2016 |