Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 25MD00201000 | NJ |
Y | 222Z00000X | Podiatrist | 25MD00201000 | NJ |
NPI | 1033180781 |
---|---|
Provider Name | Stephenia D Christian |
First Address | East Orange, NJ 07018-1951 |
Second Address | E Orange, NJ 07018 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2006 |
Last Update Date | 30/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5463106 | (05) | NJ |
U12783 | (02) |