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General NPI Number Information
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NPI Number | 1972697035
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Entity Type | Organization
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Legal Business Name | MAUREEN T CONNELLY DPM PA
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 11/16/2011
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Provider Practice Location Address
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Address Line | 22 SE 6TH ST
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City | BOCA RATON
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State | FL
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Zip | 33432-6016
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Country | US
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Telephone | 561-391-3636
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Fax | 561-395-3041
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Provider Business Mailing Address
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Address Line | 22 SE 6TH ST
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City | BOCA RATON
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State | FL
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Zip | 33432-6016
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Country | US
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Telephone | 561-391-3636
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Fax | 561-395-3041
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAUREEN T CONNELLY
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Credential | DPM
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Telephone | 561-391-3636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO2508
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License Number State | FL
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