Basic Information
| Provider Information | |||||||||
| NPI: | 1497888259 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SENISCH | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | CHARLES | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PHYSICIAN ASSISTANT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 38 PINDALE DR | ||||||||
| Address2: | |||||||||
| City: | BRIDGETON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 083024901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8564557979 | ||||||||
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| Practice Location | |||||||||
| Address1: | 414 TATUM ST | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080963499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568483880 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 25MP00011800 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | C5-0000539 | DE | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.