Provider Demographics
NPI:1124324504
Name:MCKINNEY, CEDRIC (DO)
Entity type:Individual
Prefix:DR
First Name:CEDRIC
Middle Name:
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 CRANBURY RD UNIT 906
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-8039
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:176 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2520
Practice Address - Country:US
Practice Address - Phone:212-420-0222
Practice Address - Fax:917-338-0941
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB10677100207Q00000X
NY268917207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine