MEDICARE: VINCENT K. MCINERNEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	25MA03686600	NJ

General Provider Information

NPI Number	:	1669496865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT K. MCINERNEY M.D.

Provider Business Mailing Address
First Line	:	504 VALLEY RD
Second Line	:	SUITE 200
City	:	WAYNE
State	:	NJ
Zip	:	07470-3534
Country	:	US
Telephone Number	:	973-694-2690
Fax Number	:	973-694-2692

Provider Business Practice Location Address
First Line	:	504 VALLEY RD
Second Line	:	SUITE 200
City	:	WAYNE
State	:	NJ
Zip	:	07470-3534
Country	:	US
Telephone Number	:	973-694-2690
Fax Number	:	973-694-2692

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	03/21/2008

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