Provider Demographics
NPI:1083029888
Name:DILLANE, CATHERINE
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:DILLANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:DILLANE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MB BCH BAO
Mailing Address - Street 1:2500 ENGLISH CREEK AVE
Mailing Address - Street 2:BUILDING 200, STE 211
Mailing Address - City:AEHT
Mailing Address - State:NJ
Mailing Address - Zip Code:08234
Mailing Address - Country:US
Mailing Address - Phone:609-677-7776
Mailing Address - Fax:
Practice Address - Street 1:2500 ENGLISH CREEK AVE STE 211
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5598
Practice Address - Country:US
Practice Address - Phone:609-677-7776
Practice Address - Fax:609-677-7509
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10733500207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0752371Medicaid