Individual
DEREK J MC CONNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
1325 WARREN AVE, SPRING LAKE, NJ 07762-2566
(732) 449-7855
(732) 449-7856
Mailing address
576 BROADHOLLOW RD, MELVILLE, NY 11747-5002
(631) 359-5859
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
40QA01449100
NJ
Other
Enumeration date
05/06/2013
Last updated
12/18/2020
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