Provider Demographics
NPI:1386657971
Name:DEPHILLIPS, DONNA MARIA (MD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:MARIA
Last Name:DEPHILLIPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WESTMINSTER PL
Mailing Address - Street 2:
Mailing Address - City:OLD TAPPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-6807
Mailing Address - Country:US
Mailing Address - Phone:201-666-5564
Mailing Address - Fax:
Practice Address - Street 1:7 WESTMINSTER PL
Practice Address - Street 2:
Practice Address - City:OLD TAPPAN
Practice Address - State:NJ
Practice Address - Zip Code:07675-6807
Practice Address - Country:US
Practice Address - Phone:201-666-5564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA608232081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG47468Medicare UPIN