Healthcare Provider Details

I. General information

NPI: 1710540315
Provider Name (Legal Business Name): SHEA MARIE COMADOLL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 TOWN SQUARE PL STE 208
JERSEY CITY NJ
07310-2778
US

IV. Provider business mailing address

379 CAMPUS DR FL 4
SOMERSET NJ
08873-1161
US

V. Phone/Fax

Practice location:
  • Phone: 973-322-7330
  • Fax:
Mailing address:
  • Phone: 732-937-8939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MA12051000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: