Individual
IRA SAMANTHA AGLIBUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
57 E CENTRE ST, APT 1204, NUTLEY, NJ 07110-5410
(862) 220-0045
Mailing address
57 E CENTRE ST, APT 1204, NUTLEY, NJ 07110-5410
(862) 220-0045
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
11/08/2016
Last updated
11/08/2016
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