Provider Demographics
NPI:1114135217
Name:MICHAEL J. CONN, M.D., P.C.
Entity Type:Organization
Organization Name:MICHAEL J. CONN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CONN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-836-9296
Mailing Address - Street 1:870 PALISADE AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3419
Mailing Address - Country:US
Mailing Address - Phone:201-836-9296
Mailing Address - Fax:201-836-3571
Practice Address - Street 1:870 PALISADE AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3419
Practice Address - Country:US
Practice Address - Phone:201-836-9296
Practice Address - Fax:201-836-3571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA592462086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJCO742921Medicare ID - Type Unspecified
NJF55889Medicare UPIN