Healthcare Provider Details

I. General information

NPI: 1114145356
Provider Name (Legal Business Name): JAMES P MCMENAMIN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 PARK AVE SUITE 2
PLAINFIELD NJ
07060-3026
US

IV. Provider business mailing address

1024 PARK AVENUE SUITE 2
PLAINFIELD NJ
07060
US

V. Phone/Fax

Practice location:
  • Phone: 908-757-3231
  • Fax: 908-756-0792
Mailing address:
  • Phone: 908-757-3231
  • Fax: 908-756-0792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number13904
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: