Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 25MA06656200 | NJ |
Y | 208600000X | Surgeon | 25MA06656200 | NJ |
N | 2086X0206X | Surgical Oncologist | 25MA06656200 | NJ |
NPI | 1023040771 |
---|---|
Provider Name | Dr. Michelle O'shea |
First Address | Boston, MA 02241-9430 |
Second Address | Montclair, NJ 07042-4837 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 27/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8767807 | (05) | NJ |
H48989 | (02) | NJ |