Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | MA077303 | NJ |
NPI | 1023025764 |
---|---|
Provider Name | Susan Brooks |
First Address | Red Bank, NJ 07701 |
Second Address | New Brunswick, NJ 08901-1935 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 23/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0039268 | (05) | NJ |
B17493 | (02) | NJ |