Provider Demographics
NPI:1730158379
Name:GERMAIN, VIOLAINE M-L-T (MD)
Entity type:Individual
Prefix:
First Name:VIOLAINE
Middle Name:M-L-T
Last Name:GERMAIN
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:PO BOX 946
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07207-0946
Mailing Address - Country:US
Mailing Address - Phone:973-378-3111
Mailing Address - Fax:973-378-9119
Practice Address - Street 1:2040 MILLBURN AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3726
Practice Address - Country:US
Practice Address - Phone:973-378-3111
Practice Address - Fax:973-378-9119
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA061052174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7852703Medicaid
NJ032859NSVMedicare ID - Type UnspecifiedMEDICARE