Provider Demographics
NPI:1790876860
Name:MCCANDLESS, GEORGE E (MSN)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:E
Last Name:MCCANDLESS
Suffix:
Gender:M
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 E LAUREL RD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:STRATFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08084-1362
Mailing Address - Country:US
Mailing Address - Phone:856-566-6034
Mailing Address - Fax:856-566-6208
Practice Address - Street 1:109 E LAUREL RD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1362
Practice Address - Country:US
Practice Address - Phone:856-566-6034
Practice Address - Fax:856-566-6208
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNO62133364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8103909Medicaid
NJ8103909Medicaid