Doctor Name: | BERYL SOWAH |
NPI Number: | 1992065338 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APN |
License Number: | 26NJ00378100 |
Business Practice Address: | 243 Raritan St Keyport, NJ - 077355138 |
Business Phone Number: | 7324413881 |
Business Fax Number: | |
Mailing Address: | 243 Raritan St, KEYPORT |
State: | NJ |
Postal Code: | 077355138 |
Phone Number: | 7324413881 |
Fax Number: | |
NPI Enumeration Date: | 05/19/2012 |
NPI Last Update Date: | 05/19/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | 26NJ00378100 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |