Healthcare Provider Details

I. General information

NPI: 1275329591
Provider Name (Legal Business Name): MAE ANN RAE DAQUIAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 W SHERMAN AVE
VINELAND NJ
08360-7059
US

IV. Provider business mailing address

278 E CLINTON AVE
BERGENFIELD NJ
07621-3203
US

V. Phone/Fax

Practice location:
  • Phone: 856-641-6023
  • Fax:
Mailing address:
  • Phone: 201-329-4582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: