Provider Demographics
NPI:1669497012
Name:MCNAB, THERESA CHALLENDER (MD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:CHALLENDER
Last Name:MCNAB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755-1752
Mailing Address - Country:US
Mailing Address - Phone:732-663-9518
Mailing Address - Fax:
Practice Address - Street 1:251 LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755-1752
Practice Address - Country:US
Practice Address - Phone:732-663-9518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0705492080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8231800Medicaid