Provider Demographics
NPI:1952374563
Name:MCNERNEY, JOHN E (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:MCNERNEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-1906
Mailing Address - Country:US
Mailing Address - Phone:201-664-2800
Mailing Address - Fax:201-664-5141
Practice Address - Street 1:490 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-1906
Practice Address - Country:US
Practice Address - Phone:201-664-2800
Practice Address - Fax:201-664-5141
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00101600213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0812520001Medicare NSC
T44826Medicare UPIN
NJMC180535Medicare ID - Type Unspecified