Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 25MA04340100 | NJ |
NPI | 1104898394 |
---|---|
Provider Name | Christine Donnelly |
First Address | Newark, NJ 07189-0001 |
Second Address | Morristown, NJ 07962 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 07/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A62589 | (02) | NJ |