1700184884 NPI number — PATRICIA C MCCORMACK MD PC

Table of content: (NPI 1700184884)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700184884 NPI number — PATRICIA C MCCORMACK MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATRICIA C MCCORMACK MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700184884
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
407 RICHMOND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POINT PLEASANT BEACH
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08742-2550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-926-6151
Provider Business Mailing Address Fax Number:
509-463-9780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
407 RICHMOND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POINT PLEASANT BEACH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08742-2550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-926-6151
Provider Business Practice Location Address Fax Number:
509-463-9780
Provider Enumeration Date:
03/14/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCCORMACK
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
201-926-6151

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  161216 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207N00000X , with the licence number: 25MA04075800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)