Healthcare Provider Details

I. General information

NPI: 1942216643
Provider Name (Legal Business Name): MARY GRACE MCANDREW NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 KNOLLCROFT RD
LYONS NJ
07939-5001
US

IV. Provider business mailing address

319 OLD FARM RD
GLEN GARDNER NJ
08826-3243
US

V. Phone/Fax

Practice location:
  • Phone: 908-647-0180
  • Fax: 908-604-5850
Mailing address:
  • Phone: 908-537-4432
  • Fax: 908-604-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NN07028800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NN07028800
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NO07028800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: