Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 25MA079681 | NJ |
NPI | 1114967049 |
---|---|
Provider Name | Stephanie Strozuk-Mcdonough |
First Address | Red Bank, NJ 07701 |
Second Address | Ridgewood, NJ 07450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 04/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0093017 | (05) | NJ |
I49542 | (02) |