Provider Demographics
NPI:1841415593
Name:O'CONNELL, CLAIRE BABCOCK (PA-C)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:BABCOCK
Last Name:O'CONNELL
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 1:18 BURNHAM PL
Mailing Address - Street 2:
Mailing Address - City:FLANDERS
Mailing Address - State:NJ
Mailing Address - Zip Code:07836-9517
Mailing Address - Country:US
Mailing Address - Phone:972-927-1972
Mailing Address - Fax:732-235-4820
Practice Address - Street 1:PLEASANT RUN FAMILY PHYSICIANS
Practice Address - Street 2:925 US ROUTE 202
Practice Address - City:NESHANIC STATION
Practice Address - State:NJ
Practice Address - Zip Code:08853
Practice Address - Country:US
Practice Address - Phone:908-788-9468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00002800363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant