Healthcare Provider Details

I. General information

NPI: 1467568139
Provider Name (Legal Business Name): REBECCA KATHLEEN CONNELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 TREMONT AVE PULMONARY DIVISION
EAST ORANGE NJ
07018-1023
US

IV. Provider business mailing address

385 TREMONT AVE PULMONARY DIVISION
EAST ORANGE NJ
07018-1023
US

V. Phone/Fax

Practice location:
  • Phone: 973-676-1000
  • Fax: 973-395-7034
Mailing address:
  • Phone: 973-676-1000
  • Fax: 973-395-7034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MA06037300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: