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General NPI Number Information
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NPI Number | 1508228073
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Entity Type | Individual
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Provider Name | DANIELA CORREA MD
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Gender | Female
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Dates
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Enumeration Date | 03/24/2016
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Last Update Date | 08/14/2019
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Provider Practice Location Address
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Address Line | 123 HOW LN
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901-3653
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Country | US
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Telephone | 732-745-8519
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Fax |
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Provider Business Mailing Address
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Address Line | 500 STATION DR APT 515
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City | AVENEL
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State | NJ
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Zip | 07001-1800
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Country | US
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Telephone | 347-552-7674
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 25MA105307006
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License Number State | NJ
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