Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 25MA05506300 | NJ |
Y | 207RP1001X | Pulmonary Disease | 25MA05506300 | NJ |
NPI | 1063482396 |
---|---|
Provider Name | Dr. Gregory John Cunningham |
First Address | Sea Girt, NJ 08750-2805 |
Second Address | Sea Girt, NJ 08750-2805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 09/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5605407 | (05) | NJ |
F51855 | (02) | NJ |