Provider Demographics
NPI:1366648966
Name:MCNEIL, SUE ELLEN (PA)
Entity Type:Individual
Prefix:MS
First Name:SUE
Middle Name:ELLEN
Last Name:MCNEIL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:SUE
Other - Middle Name:ELLEN
Other - Last Name:MANNIX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:776 SHREWSBURY AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-4507
Mailing Address - Country:US
Mailing Address - Phone:732-530-4949
Mailing Address - Fax:732-212-1171
Practice Address - Street 1:776 SHREWSBURY AVE STE 201
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07724-4507
Practice Address - Country:US
Practice Address - Phone:732-530-4949
Practice Address - Fax:732-212-1171
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00052200363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant