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General NPI Number Information
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NPI Number | 1194925644
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Entity Type | Individual
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Provider Name | CHRISTIAN PAUL MCDONOUGH MD
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Gender | Male
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 09/21/2011
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Provider Practice Location Address
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Address Line | 351 MAYWOOD AVE FL 2
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City | MAYWOOD
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State | NJ
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Zip | 07607-1906
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Country | US
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Telephone | 201-546-1374
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Fax |
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Provider Business Mailing Address
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Address Line | 351 MAYWOOD AVE FL 2
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City | MAYWOOD
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State | NJ
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Zip | 07607-1906
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Country | US
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Telephone | 201-546-1374
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 25MA08741600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 275N00000X
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Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
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License Number | 240836
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License Number State | NY
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