Provider Demographics
NPI:1265894703
Name:PHILIPS, MARYAN N (DO)
Entity type:Individual
Prefix:
First Name:MARYAN
Middle Name:N
Last Name:PHILIPS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 NORTHFIELD AVE STE LL2
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3023
Mailing Address - Country:US
Mailing Address - Phone:973-736-4442
Mailing Address - Fax:
Practice Address - Street 1:405 NORTHFIELD AVE STE LL2
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-3023
Practice Address - Country:US
Practice Address - Phone:973-736-4442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB10547400208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics