Individual
MINI ROY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
201 LYONS AVE, NEWARK, NJ 07112-2027
(973) 926-7754
Mailing address
22 BROOKSIDE PL, LIVINGSTON, NJ 07039-4034
(908) 810-1835
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
26NJ00553600
NJ
363LG0600X
Gerontology Nurse Practitioner
26NJ00553600
NJ
363LP2300X
Primary Care Nurse Practitioner
26NJ00553600
NJ
Other
Enumeration date
02/17/2015
Last updated
02/17/2015
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