Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 25MA08934400 | NJ |
NPI | 1003042490 |
---|---|
Provider Name | Trina Doreen Banerjee |
First Address | Mullica Hill, NJ 08062-9514 |
Second Address | Mullica Hill, NJ 08062 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2009 |
Last Update Date | 12/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0474339 | (05) | NJ |