Provider Demographics
NPI:1922177849
Name:O'CONNOR, EILEEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:M
Last Name:O'CONNOR
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 1:1317 S MAIN RD
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6511
Mailing Address - Country:US
Mailing Address - Phone:856-691-7304
Mailing Address - Fax:856-691-8575
Practice Address - Street 1:1317 S MAIN RD
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6511
Practice Address - Country:US
Practice Address - Phone:856-691-7304
Practice Address - Fax:856-691-8575
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0400952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJA01507043OtherDEA#
NJC54830Medicare UPIN
NJ447127Medicare ID - Type UnspecifiedMEDICARE