Provider Demographics
NPI:1053600882
Name:MCINTIRE, CURTIS W
Entity type:Individual
Prefix:MR
First Name:CURTIS
Middle Name:W
Last Name:MCINTIRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1260
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-0890
Mailing Address - Country:US
Mailing Address - Phone:856-362-9074
Mailing Address - Fax:
Practice Address - Street 1:13 DAVE'S DR.
Practice Address - Street 2:
Practice Address - City:FAIRTON
Practice Address - State:NJ
Practice Address - Zip Code:08302
Practice Address - Country:US
Practice Address - Phone:856-362-9074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist