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General NPI Number Information
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NPI Number | 1326710914
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Entity Type | Individual
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Provider Name | BARBARA MARIE HANNAN PA
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Gender | Female
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Dates
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Enumeration Date | 10/01/2021
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Last Update Date | 10/01/2021
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Provider Practice Location Address
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Address Line | 120 VALLEY RD
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2321
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Country | US
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Telephone | 201-490-4333
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Fax |
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Provider Business Mailing Address
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Address Line | 5000 RIVERDALE RD APT 116
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City | RIVERDALE
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State | NJ
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Zip | 07457-1724
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Country | US
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Telephone | 862-354-7972
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00649300
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License Number State | NJ
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