Provider Demographics
NPI:1578654786
Name:NEKORANIK, MICHAEL G (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:NEKORANIK
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 1:123B ROSEBERRY ST
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1629
Mailing Address - Country:US
Mailing Address - Phone:908-213-3433
Mailing Address - Fax:908-213-3647
Practice Address - Street 1:123B ROSEBERRY ST
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1629
Practice Address - Country:US
Practice Address - Phone:908-213-3433
Practice Address - Fax:908-213-3647
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB59157207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ110224540OtherRAILROAD MEDICARE
NJ7105207Medicaid
PA110219308OtherRAILROAD MEDICARE
NJ7105207Medicaid
PA607241Medicare PIN
NJ582191Medicare PIN