| Doctor Name: | MRS. MAUREEN MCDONOUGH |
| NPI Number: | 1003855370 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | C-APN |
| License Number: | 26NN08629100 |
| Business Practice Address: | 5301 Broadway West New York, NJ - 070932622 |
| Business Phone Number: | 2018669320 |
| Business Fax Number: | |
| Mailing Address: | 608 Larch St, ROSELLE PARK |
| State: | NJ |
| Postal Code: | 072041603 |
| Phone Number: | 9082457562 |
| Fax Number: | |
| NPI Enumeration Date: | 06/05/2006 |
| NPI Last Update Date: | 01/24/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 26NN08629100 |
| 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: | |