Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1194312769 |
---|---|
Provider Name | Sandra Ellen Terminiello |
First Address | Lakewood, NJ 08701-3018 |
Second Address | Lakewood, NJ 08701-3018 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2020 |
Last Update Date | 29/12/2020 |