Provider Demographics
NPI:1043361793
Name:MCGRATH, MILDRED ALICE (APNC)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:ALICE
Last Name:MCGRATH
Suffix:
Gender:F
Credentials:APNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 VALLEY RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MOUNT ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07856-2316
Mailing Address - Country:US
Mailing Address - Phone:973-770-7899
Mailing Address - Fax:973-770-7840
Practice Address - Street 1:400 VALLEY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MOUNT ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07856-2316
Practice Address - Country:US
Practice Address - Phone:973-770-7899
Practice Address - Fax:973-770-7840
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN05911200363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8442703Medicaid
NJP21395Medicare UPIN
NJ044286QTLMedicare ID - Type Unspecified