Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 25MA04750000 | NJ |
NPI | 1194752584 |
---|---|
Provider Name | Vijaya Prasad |
First Address | Paterson, NJ 07503-2621 |
Second Address | Paterson, NJ 07503-2621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7875207 | (05) | NJ |