Provider Demographics
NPI:1831550706
Name:MCINTYRE, MICHAEL F (CNIM)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1989 CORRAL PATH
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-2412
Mailing Address - Country:US
Mailing Address - Phone:631-466-7864
Mailing Address - Fax:
Practice Address - Street 1:1086 TEANECK RD STE 4A
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4858
Practice Address - Country:US
Practice Address - Phone:484-351-8459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1998246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic