Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 25MA07011500 | NJ |
NPI | 1275647216 |
---|---|
Provider Name | Dr. Brian Kevin O'connor |
First Address | West Orange, NJ 07052-2724 |
Second Address | West Orange, NJ 07052-2724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 30/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6617000 | (05) | NJ |
E95646 | (02) | NJ |