Provider Demographics
NPI:1053611632
Name:MULLEN, PATRICK THOMAS
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:THOMAS
Last Name:MULLEN
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 1:4921 HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08226-1458
Mailing Address - Country:US
Mailing Address - Phone:609-573-2226
Mailing Address - Fax:
Practice Address - Street 1:4921 HAVEN AVE
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:NJ
Practice Address - Zip Code:08226-1458
Practice Address - Country:US
Practice Address - Phone:609-573-2226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver