Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 25MA07355800 | NJ |
N | 2081P2900X | Pain Medicine | MD065466L | PA |
NPI | 1285688747 |
---|---|
Provider Name | Theodore David Conliffe JR. |
First Address | Philadelphia, PA 19107-4430 |
Second Address | Marlton, NJ 08053-1227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 19/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0768790000 | IBC (01) | PA |
2124376000 | IBC (01) | NJ |
2678030 | AETNA (01) | PA |
2740687 | AETNA (01) | NJ |
6719765 | CIGNA (01) | |
G44405 | (02) |