Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0201X | Pediatric Allergist | 128013 | NY |
N | 2080P0201X | Pediatric Allergist | 25MA07289900 | NJ |
N | 2080P0216X | Pediatric Rheumatologist | 128013 | NY |
Y | 2080P0216X | Pediatric Rheumatologist | 25MA07289900 | NJ |
NPI | 1912952417 |
---|---|
Provider Name | Dr. Kathleen Ann Haines |
First Address | Hackensack, NJ 07601-1914 |
Second Address | Hackensack, NJ 07601-1914 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 05/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F47880 | (02) | NJ |