Provider Demographics
NPI:1497909279
Name:DELOUGHRY, CHRISTINE A (OTR)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:A
Last Name:DELOUGHRY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:A
Other - Last Name:DELOUGHRY-LAMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:438 MILLBURN AVE
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1210
Mailing Address - Country:US
Mailing Address - Phone:973-379-1314
Mailing Address - Fax:973-379-1314
Practice Address - Street 1:438 MILLBURN AVE
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1210
Practice Address - Country:US
Practice Address - Phone:973-379-1314
Practice Address - Fax:973-379-1314
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0006956172V00000X
NJ46TR00246300172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker