Healthcare Provider Details

I. General information

NPI: 1831304682
Provider Name (Legal Business Name): GERALDINE REDMOND PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BERGEN ST. E - LEVEL RM# E346
NEWARK NJ
07103
US

IV. Provider business mailing address

150 BERGEN ST. E - LEVEL RM# E346
NEWARK NJ
07103
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-1110
  • Fax: 973-972-6541
Mailing address:
  • Phone: 973-972-1110
  • Fax: 973-972-6541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00120200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: