Individual
SONY MYTIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
56 MCKINLEY AVE, COLONIA, NJ 07067-2310
(732) 473-7726
Mailing address
56 MCKINLEY AVE, COLONIA, NJ 07067-2310
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
80551601
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
80551601
—
NY
Enumeration date
01/11/2021
Last updated
01/11/2021
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