Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | MA66138 | NJ |
NPI | 1114970183 |
---|---|
Provider Name | Kathleen Patricia O'hara |
First Address | Hackensack, NJ 07601-3231 |
Second Address | Hackensack, NJ 07601-3231 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 10/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G58106 | (02) | NJ |