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General NPI Number Information
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NPI Number | 1912133810
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Entity Type | Individual
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Provider Name | MARY JEAN O MD
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Gender | Female
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Dates
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Enumeration Date | 06/05/2009
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Last Update Date | 10/28/2020
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Provider Practice Location Address
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Address Line | 1 ROBERT WOOD JOHNSON PL DEPARTMENT OF EMERGENCY MEDICINE
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901-1928
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Country | US
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Telephone | 732-937-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 2800 MAIN ST
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City | BRIDGEPORT
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State | CT
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Zip | 06606-4201
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Country | US
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Telephone | 475-210-5604
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 51520
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 267682
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 25MA09247300
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License Number State | NJ
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