Provider Demographics
NPI:1336498526
Name:CONNOLLY, KATHLEEN A (APN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 OLD HOOK RD
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-3117
Mailing Address - Country:US
Mailing Address - Phone:201-358-0505
Mailing Address - Fax:201-358-1515
Practice Address - Street 1:270 OLD HOOK RD
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3117
Practice Address - Country:US
Practice Address - Phone:201-358-0505
Practice Address - Fax:201-358-1515
Is Sole Proprietor?:No
Enumeration Date:2012-09-03
Last Update Date:2012-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00354700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily