Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | P57285 | NY |
NPI | 1326287319 |
---|---|
Provider Name | Siema A Eljack |
First Address | Plainsboro, NJ 08536-2003 |
Second Address | Plainsboro, NJ 08536-2003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2009 |
Last Update Date | 19/01/2012 |