Provider Demographics
NPI:1730264292
Name:MCGUIRE, PATRICIA LEE (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LEE
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 NORTH BROAD STREET
Mailing Address - Street 2:SUITE 507
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3856
Mailing Address - Country:US
Mailing Address - Phone:201-445-8004
Mailing Address - Fax:201-445-8005
Practice Address - Street 1:45 N BROAD ST
Practice Address - Street 2:SUITE 507
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3856
Practice Address - Country:US
Practice Address - Phone:201-445-8004
Practice Address - Fax:201-445-8005
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA049336002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE 53066Medicare UPIN