Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 26NJ01237000 | NJ |
NPI | 1104586031 |
---|---|
Provider Name | Stephanie Simonetti |
First Address | Cherry Hill, NJ 08002-2223 |
Second Address | Cherry Hill, NJ 08002-2223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2021 |
Last Update Date | 20/12/2021 |