Provider Demographics
NPI:1528451507
Name:DONNA M. DEPHILLIPS LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:DONNA M. DEPHILLIPS LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEPHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-417-4931
Mailing Address - Street 1:PO BOX 2098
Mailing Address - Street 2:
Mailing Address - City:RIVER VALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-9001
Mailing Address - Country:US
Mailing Address - Phone:201-417-4931
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:201-417-4931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-14
Last Update Date:2015-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA60823208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty