Provider Demographics
NPI:1851491625
Name:MCWEENEY, MICHELLE LYNNE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:LYNNE
Last Name:MCWEENEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 BRITTANY CT
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2674
Mailing Address - Country:US
Mailing Address - Phone:973-837-8814
Mailing Address - Fax:732-745-9107
Practice Address - Street 1:24 ABEEL STREET
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901
Practice Address - Country:US
Practice Address - Phone:732-745-9800
Practice Address - Fax:732-745-9107
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ MP504363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ048910Medicare ID - Type Unspecified