Individual
DIANE CONNORS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
455 JACK MARTIN BLVD, BRICK, NJ 08724-7732
(609) 652-6815
(609) 652-6270
Mailing address
72 W JIMMIE LEEDS RD, STE 1100, GALLOWAY, NJ 08205-9406
(609) 677-9729
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
25MA04956600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0106801
—
NJ
01
—
P00847982
RAILROAD MEDICARE
NJ
Enumeration date
06/13/2006
Last updated
11/22/2011
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