Doctor Name: | MAUREEN N CONNOLLY |
NPI Number: | 1063804623 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 26NJ00533000 |
Business Practice Address: | 130 Speedwell Ave Morris Plains, NJ - 079502315 |
Business Phone Number: | 8622428053 |
Business Fax Number: | |
Mailing Address: | 522 Buchanan Blvd, RED BANK |
State: | NJ |
Postal Code: | 077015355 |
Phone Number: | 7326742295 |
Fax Number: | |
NPI Enumeration Date: | 02/19/2015 |
NPI Last Update Date: | 09/19/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 26NJ00533000 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |