Provider Demographics
NPI:1174744783
Name:MCNEILLY, ERIN
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:MCNEILLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 COUNTY ROAD 520 STE B101
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1089
Mailing Address - Country:US
Mailing Address - Phone:732-856-5999
Mailing Address - Fax:
Practice Address - Street 1:479 COUNTY ROAD 520 STE B101
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-1089
Practice Address - Country:US
Practice Address - Phone:732-856-5999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00464800363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant