Basic Information
| Provider Information | |||||||||
| NPI: | 1497175996 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPOHN | ||||||||
| FirstName: | MARY ELLEN | ||||||||
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| Credential: | MPA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 GALWAY PL 300 | ||||||||
| Address2: | |||||||||
| City: | TEANECK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076663640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018339500 | ||||||||
| FaxNumber: | 2018620095 | ||||||||
| Practice Location | |||||||||
| Address1: | 750 VALLEY BROOK AVE | ||||||||
| Address2: | |||||||||
| City: | LYNDHURST | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070711301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018960900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2014 | ||||||||
| LastUpdateDate: | 11/04/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 25MP00322800 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.