Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | 25MS00001100 | NJ |
NPI | 1104998814 |
---|---|
Provider Name | Dr. Michael Kevin Mccormack |
First Address | Mantoloking, NJ 08738-1620 |
Second Address | Stratford, NJ 08084-1354 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 08/07/2007 |