Healthcare Provider Details

I. General information

NPI: 1831588599
Provider Name (Legal Business Name): MARIAN HALLIGAN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 S LAUREL ST
BRIDGETON NJ
08302-1946
US

IV. Provider business mailing address

640 WEST AVE
WEST CAPE MAY NJ
08204-1005
US

V. Phone/Fax

Practice location:
  • Phone: 856-451-4700
  • Fax: 856-794-7183
Mailing address:
  • Phone: 609-923-3653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number22HI00291900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: