1952401630 NPI number — CYNTHIA A GRIECH-MCCLEERY MD

Table of content: CYNTHIA A GRIECH-MCCLEERY MD (NPI 1952401630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952401630 NPI number — CYNTHIA A GRIECH-MCCLEERY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRIECH-MCCLEERY
Provider First Name:
CYNTHIA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1952401630
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 FELLOWSHIP RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
MOUNT LAUREL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08054-3419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-963-3572
Provider Business Mailing Address Fax Number:
856-338-9211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 FELLOWSHIP RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
MOUNT LAUREL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08054-3419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-963-3572
Provider Business Practice Location Address Fax Number:
856-338-9211
Provider Enumeration Date:
09/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  MA58179 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9573829 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 15382 . This is a "UNIVERSITY HEALTHPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 880004 . This is a "AMERIHEALTH PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: CA0000228 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1020632 . This is a "HORIZON NJ HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3K6076 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: P406168 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0993264000 . This is a "AMERIHEALTH HMO, KEYSTONE, IBC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7019602 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0578049 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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