Individual
DR. EILEEN M TRAVERS CONCANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
34 WILLOW DR, CHESTER, NJ 07930-2812
(908) 625-5187
Mailing address
560 S BROADWAY, HICKSVILLE, NY 11801-5013
(516) 933-2200
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
25MA03766300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0291404
—
NJ
Enumeration date
10/11/2006
Last updated
10/29/2010
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