Provider Demographics
NPI:1952651135
Name:CUNNINGHAM, JOSEPH DANIEL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:DANIEL
Last Name:CUNNINGHAM
Suffix:
Gender:M
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 1:1200 US HIGHWAY 22 STE 14
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2943
Mailing Address - Country:US
Mailing Address - Phone:917-575-6302
Mailing Address - Fax:
Practice Address - Street 1:215 EAST 68TH STREET APT 17ZZ
Practice Address - Street 2:APT 17ZZ
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065
Practice Address - Country:US
Practice Address - Phone:917-575-6302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015721363A00000X
NJ25MP00792000363AS0400X
CT003414363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant