Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | MA60823 | NJ |
NPI | 1386657971 |
---|---|
Provider Name | Dr. Donna Maria Dephillips |
First Address | Old Tappan, NJ 07675-6807 |
Second Address | Old Tappan, NJ 07675-6807 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 08/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G47468 | (02) | NJ |