Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0210X | Pediatric Nephrologist | 25MA07963200 | NJ |
Y | 2080P0210X | Pediatric Nephrologist | MD063184L | PA |
NPI | 1639198435 |
---|---|
Provider Name | Susan B Conley |
First Address | Philadelphia, PA 19134-1043 |
Second Address | Philadelphia, PA 19134-1043 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 18/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0016642200003 | (05) | PA |
2748937000 | AMERIHEALTH KEYSTONE (01) | |
60025871 | HORIZON NJ HEALTH (01) | NJ |
7527608 | (05) | NJ |
B21966 | (02) | PA |