Provider Demographics
NPI:1407836984
Name:CONNOR, MARY EILEEN (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:EILEEN
Last Name:CONNOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 DAYTON RD
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-2616
Mailing Address - Country:US
Mailing Address - Phone:908-766-1407
Mailing Address - Fax:
Practice Address - Street 1:150 N FINLEY AVE
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-1686
Practice Address - Country:US
Practice Address - Phone:908-766-1407
Practice Address - Fax:908-953-8454
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00142900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ027505NEPMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER