Provider Demographics
NPI:1881752137
Name:MCHALE, MICHAEL E (CPED)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:MCHALE
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-1401
Mailing Address - Country:US
Mailing Address - Phone:609-267-6766
Mailing Address - Fax:609-518-2087
Practice Address - Street 1:101 HIGH ST
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-1401
Practice Address - Country:US
Practice Address - Phone:609-267-6766
Practice Address - Fax:609-518-2087
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ9592174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0029041Medicaid
NJ3389390OtherDME
NJ3389390OtherDME