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General NPI Number Information
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NPI Number | 1164554564
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Entity Type | Individual
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Provider Name | JAMES MARK CONNERAN PH D
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Gender | Male
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 02/26/2010
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Provider Practice Location Address
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Address Line | 220 RUES LN
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816
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Country | US
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Telephone | 732-257-7715
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Fax | 732-613-9757
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Provider Business Mailing Address
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Address Line | 19 MAYWOOD DR
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City | MARLBORO
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State | NJ
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Zip | 07746-1026
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Country | US
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Telephone | 732-536-3919
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Fax | 732-536-7569
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 35S100435600
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License Number State | NJ
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