Provider Demographics
NPI:1043643901
Name:MICHAEL CUNNINGHAM MD, LLC
Entity Type:Organization
Organization Name:MICHAEL CUNNINGHAM MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-962-7569
Mailing Address - Street 1:547 E BROAD ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2107
Mailing Address - Country:US
Mailing Address - Phone:908-962-7569
Mailing Address - Fax:908-603-8794
Practice Address - Street 1:547 E BROAD ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2107
Practice Address - Country:US
Practice Address - Phone:908-962-7569
Practice Address - Fax:908-603-8794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08202700207R00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty