Provider Demographics
NPI:1780649392
Name:MAHER, MICHAEL L (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:MAHER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 US HIGHWAY 46
Mailing Address - Street 2:VILLAGE GREEN ANNEX
Mailing Address - City:BUDD LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07828
Mailing Address - Country:US
Mailing Address - Phone:973-347-0500
Mailing Address - Fax:973-347-1512
Practice Address - Street 1:98 US HIGHWAY 46
Practice Address - Street 2:VILLAGE GREEN ANNEX
Practice Address - City:BUDD LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07828-1818
Practice Address - Country:US
Practice Address - Phone:973-347-0500
Practice Address - Fax:973-347-1512
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00646400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU82524Medicare UPIN
NJ099733Medicare ID - Type Unspecified