Provider Demographics
NPI:1285618348
Name:MCTIGUE, MAUREEN A (DO)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:A
Last Name:MCTIGUE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2103
Mailing Address - Country:US
Mailing Address - Phone:201-488-0066
Mailing Address - Fax:201-488-6769
Practice Address - Street 1:30 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1914
Practice Address - Country:US
Practice Address - Phone:201-488-0066
Practice Address - Fax:201-488-6769
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05791500207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01950132Medicaid
NJ2205437000OtherAMERIHEALTH- HMO
NJ37613OtherAMERIGROUP
NJ1111812OtherHORIZON NJ HEALTH- MERCY
NJ1518020OtherAMERIHEALTH- PPO
NJ7550103Medicaid
G08576Medicare UPIN
NJ1111812OtherHORIZON NJ HEALTH- MERCY