Provider Demographics
NPI:1831304682
Name:REDMOND, GERALDINE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:GERALDINE
Middle Name:
Last Name:REDMOND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BERGEN ST.
Mailing Address - Street 2:E - LEVEL RM# E346
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103
Mailing Address - Country:US
Mailing Address - Phone:973-972-1110
Mailing Address - Fax:973-972-6541
Practice Address - Street 1:150 BERGEN ST.
Practice Address - Street 2:E - LEVEL RM# E346
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103
Practice Address - Country:US
Practice Address - Phone:973-972-1110
Practice Address - Fax:973-972-6541
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00120200363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical