Provider Demographics
NPI:1700184884
Name:PATRICIA C MCCORMACK MD PC
Entity Type:Organization
Organization Name:PATRICIA C MCCORMACK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCCORMACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-926-6151
Mailing Address - Street 1:407 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-2550
Mailing Address - Country:US
Mailing Address - Phone:201-926-6151
Mailing Address - Fax:509-463-9780
Practice Address - Street 1:407 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BEACH
Practice Address - State:NJ
Practice Address - Zip Code:08742-2550
Practice Address - Country:US
Practice Address - Phone:201-926-6151
Practice Address - Fax:509-463-9780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-14
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161216207N00000X
NJ25MA04075800207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ239536Medicare PIN
NYA100068331Medicare PIN