Individual
POOJA H DIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
300 2ND AVE, LONG BRANCH, NJ 07740-6395
(732) 222-5200
Mailing address
300 2ND AVE, LONG BRANCH, NJ 07740-6303
(732) 222-5200
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
22DI03025600
NJ
390200000X
Student in an Organized Health Care Education/Training Program
22DR03833
NJ
Other
Enumeration date
06/07/2023
Last updated
05/31/2024
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