Healthcare Provider Details

I. General information

NPI: 1336168608
Provider Name (Legal Business Name): MARIA VIRGINIA PADRON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 68TH ST
GUTTENBERG NJ
07093-2409
US

IV. Provider business mailing address

412 WYOMING AVE
MILLBURN NJ
07041-2107
US

V. Phone/Fax

Practice location:
  • Phone: 201-861-7639
  • Fax:
Mailing address:
  • Phone: 201-861-7639
  • Fax: 908-994-7354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMA033433
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMA033433
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: