Healthcare Provider Details

I. General information

NPI: 1629169990
Provider Name (Legal Business Name): HEATHER L MCGINN PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W MAIN ST
FREEHOLD NJ
07728-2537
US

IV. Provider business mailing address

PO BOX 412826
BOSTON MA
02241-2526
US

V. Phone/Fax

Practice location:
  • Phone: 732-294-2934
  • Fax: 732-294-2582
Mailing address:
  • Phone: 844-362-1735
  • Fax: 973-290-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00138100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: