Individual
FRADI J. BACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
325 11TH ST, LAKEWOOD, NJ 08701-1825
(732) 616-3838
(732) 905-5591
Mailing address
325 11TH ST, LAKEWOOD, NJ 08701-1825
(732) 616-3838
(732) 905-5591
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
659045
NY
Other
Enumeration date
09/12/2012
Last updated
09/12/2012
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