Provider Demographics
NPI:1497070775
Name:CODOYANNIS, VERONICA CONCEPCION (MD)
Entity Type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:CONCEPCION
Last Name:CODOYANNIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13 GLENNON FARM LANE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NJ
Mailing Address - Zip Code:08833
Mailing Address - Country:US
Mailing Address - Phone:908-832-5095
Mailing Address - Fax:908-832-7034
Practice Address - Street 1:13 GLENNON FARM LN
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NJ
Practice Address - Zip Code:08833-4504
Practice Address - Country:US
Practice Address - Phone:908-832-5095
Practice Address - Fax:908-832-7034
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03554600208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics