Individual
JACQUELINE M FACCONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
63 RIDGE RD, GREEN BROOK, NJ 08812
(732) 537-0310
Mailing address
63 RIDGE RD, GREEN BROOK, NJ 08812
(732) 537-0310
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MB62797
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7032404
—
NJ
Enumeration date
04/10/2007
Last updated
05/29/2008
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