Basic Information
| Provider Information | |||||||||
| NPI: | 1871580639 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SNYDER | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 SALEM RD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | WILLINGBORO | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080462852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098712060 | ||||||||
| FaxNumber: | 6098713535 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 SALEM RD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | WILLINGBORO | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080462852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098712060 | ||||||||
| FaxNumber: | 6098713535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2005 | ||||||||
| LastUpdateDate: | 05/11/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MA59333 | NJ | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 5514002 | 05 | NJ | MEDICAID |