Basic Information
Provider Information
NPI: 1619073434
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TWOMEY
FirstName: AILEEN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: APN
OtherOrganizationName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 419430
Address2:  
City: BOSTON
State: MA
PostalCode: 022419430
CountryCode: US
TelephoneNumber: 2016663900
FaxNumber: 2012610505
Practice Location
Address1: 452 OLD HOOK RD
Address2: 2ND FLOOR
City: EMERSON
State: NJ
PostalCode: 076301381
CountryCode: US
TelephoneNumber: 2016663900
FaxNumber: 2012610505
Other Information
ProviderEnumerationDate: 09/16/2006
LastUpdateDate: 04/28/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XNN88908NJY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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