Provider Demographics
NPI:1336344365
Name:PILOT MCDERMOTT INC
Entity Type:Organization
Organization Name:PILOT MCDERMOTT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MCDERMOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-741-8668
Mailing Address - Street 1:561 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FAIR HAVEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07704
Mailing Address - Country:US
Mailing Address - Phone:732-741-8668
Mailing Address - Fax:732-842-2128
Practice Address - Street 1:561 RIVER RD
Practice Address - Street 2:
Practice Address - City:FAIR HAVEN
Practice Address - State:NJ
Practice Address - Zip Code:07704
Practice Address - Country:US
Practice Address - Phone:732-741-8668
Practice Address - Fax:732-842-2128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC03684111N00000X
NJMC03327111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0042765Medicaid
NJ69623452ZMedicare ID - Type Unspecified
V32131Medicare UPIN
NJ0042765Medicaid