Provider Demographics
NPI:1942204904
Name:MCDERMOTT, JANETTE HELENA (MD)
Entity Type:Individual
Prefix:
First Name:JANETTE
Middle Name:HELENA
Last Name:MCDERMOTT
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 1:173 ESSEX AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840
Mailing Address - Country:US
Mailing Address - Phone:732-494-0415
Mailing Address - Fax:732-494-1474
Practice Address - Street 1:173 ESSEX AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840
Practice Address - Country:US
Practice Address - Phone:732-494-0415
Practice Address - Fax:732-494-1474
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA62618208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
821550Medicare ID - Type Unspecified
F51423Medicare UPIN