Healthcare Provider Details

I. General information

NPI: 1477510782
Provider Name (Legal Business Name): MICHAEL B O'NEILL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 SPARTA AVE
SPARTA NJ
07871
US

IV. Provider business mailing address

328 SPARTA AVE
SPARTA NJ
07871
US

V. Phone/Fax

Practice location:
  • Phone: 973-729-2197
  • Fax: 973-729-5653
Mailing address:
  • Phone: 973-729-2197
  • Fax: 973-729-5653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA029820
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD044367L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: