Provider Demographics
NPI:1376773846
Name:ELLEN E CUNNINGHAM MD,LLC
Entity Type:Organization
Organization Name:ELLEN E CUNNINGHAM MD,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-785-8686
Mailing Address - Street 1:1425 POMPTON AVE STE 1-1
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1043
Mailing Address - Country:US
Mailing Address - Phone:973-785-8686
Mailing Address - Fax:973-785-8680
Practice Address - Street 1:1425 POMPTON AVE STE 1-1
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1043
Practice Address - Country:US
Practice Address - Phone:973-785-8686
Practice Address - Fax:973-785-8680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-20
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07362900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH26347Medicare UPIN