=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639365836
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL JAMES CUNNINGHAM M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2007
-----------------------------------------------------
Last Update Date | 11/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 547 E BROAD ST 2ND FLOOR
-----------------------------------------------------
City | WESTFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07090-2107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-264-2454
-----------------------------------------------------
Fax | 908-603-8794
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 547 E BROAD ST 2ND FLOOR
-----------------------------------------------------
City | WESTFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07090-2107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-264-2454
-----------------------------------------------------
Fax | 908-603-8794
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 25MA08202700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 25MA08202700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------