Provider Demographics
NPI:1467454066
Name:COMANDATORE, ANN MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:
Last Name:COMANDATORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 MILLBURN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1945
Mailing Address - Country:US
Mailing Address - Phone:973-378-7990
Mailing Address - Fax:973-378-7991
Practice Address - Street 1:90 MILLBURN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1945
Practice Address - Country:US
Practice Address - Phone:973-378-7990
Practice Address - Fax:973-378-7991
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05642100208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8774200Medicaid