1295738136 NPI number — DR. JOHN MCCLUNG MD

Table of content: DR. JOHN MCCLUNG MD (NPI 1295738136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295738136 NPI number — DR. JOHN MCCLUNG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCLUNG
Provider First Name:
JOHN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295738136
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 WOODS RD
Provider Second Line Business Mailing Address:
TCC ROOM D368
Provider Business Mailing Address City Name:
VALHALLA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10595-1530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-493-7530
Provider Business Mailing Address Fax Number:
914-493-5827

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 BRADHURST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAWTHORNE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10532-2140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-909-6900
Provider Business Practice Location Address Fax Number:
914-493-2828
Provider Enumeration Date:
05/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  1275841 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00712083 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060023508 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 76A93K221 . This is a "PTAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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