Provider Demographics
NPI:1093810749
Name:MCGILL, WINSTON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WINSTON
Middle Name:
Last Name:MCGILL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-3414
Mailing Address - Country:US
Mailing Address - Phone:973-677-1144
Mailing Address - Fax:973-677-9145
Practice Address - Street 1:258 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-3414
Practice Address - Country:US
Practice Address - Phone:973-677-1144
Practice Address - Fax:973-677-9145
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03335700208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0271101Medicaid
NJD19912Medicare UPIN