Provider Demographics
NPI:1154317063
Name:MCCONNELL, JOHN C (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:MCCONNELL
Suffix:
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 1:4-14 SADDLE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-5632
Mailing Address - Country:US
Mailing Address - Phone:201-791-4002
Mailing Address - Fax:201-791-7040
Practice Address - Street 1:4-14 SADDLE RIVER RD
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-5632
Practice Address - Country:US
Practice Address - Phone:201-791-4002
Practice Address - Fax:201-791-7040
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA37662208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMAI0439207Medicaid
NJC60866Medicare UPIN
NJMAI0439207Medicaid