Provider Demographics
NPI:1275706202
Name:MCCOY REDD, LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:
Last Name:MCCOY REDD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 MANOR DR
Mailing Address - Street 2:APT. C
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-4567
Mailing Address - Country:US
Mailing Address - Phone:908-688-1412
Mailing Address - Fax:
Practice Address - Street 1:865 STONE ST
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065
Practice Address - Country:US
Practice Address - Phone:732-499-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08384000207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0184047Medicaid