Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | 25MB09911500 | NJ |
NPI | 1124361878 |
---|---|
Provider Name | Tina Dhebaria |
First Address | Neptune, NJ 07753-4858 |
Second Address | Neptune, NJ 07753 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2013 |
Last Update Date | 21/08/2019 |