Provider Demographics
NPI:1831164318
Name:SKEEHAN, CHRISTOPHER (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:SKEEHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-1703
Mailing Address - Country:US
Mailing Address - Phone:732-462-9622
Mailing Address - Fax:732-780-0014
Practice Address - Street 1:158 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HIGHTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08520-3346
Practice Address - Country:US
Practice Address - Phone:609-426-1555
Practice Address - Fax:732-780-0014
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-20
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05919200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7461402Medicaid
NJ5450101Medicaid
NJA28123Medicare UPIN
NJ400579Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
NJ7461402Medicaid