Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 18KT00911000 | NJ |
NPI | 1043764061 |
---|---|
Provider Name | Stacy Davidson |
First Address | Livingston, NJ 07039-1308 |
Second Address | Livingston, NJ 07039-1308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2016 |
Last Update Date | 08/08/2016 |