Provider Demographics
NPI:1831274273
Name:MCCROSSIN, JAMES MICHAEL (ATC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MICHAEL
Last Name:MCCROSSIN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 87TH ST
Mailing Address - Street 2:
Mailing Address - City:STONE HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08247-1621
Mailing Address - Country:US
Mailing Address - Phone:856-309-4416
Mailing Address - Fax:856-309-4455
Practice Address - Street 1:601 LAUREL OAK RD
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4423
Practice Address - Country:US
Practice Address - Phone:856-309-4416
Practice Address - Fax:856-309-4455
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT00090400146D00000X
NJ25MT00904002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant