MEDICARE: ROBERT J MCCORD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	002007-1	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	970014578	OTHER	NY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P2586035	OTHER	NY	OXFORD

General Provider Information

NPI Number	:	1346243268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT J MCCORD PA

Provider Business Mailing Address
First Line	:	206 EAST JERICHO TURNPIKE
Second Line	:
City	:	HUNTINGTON STATION
State	:	NY
Zip	:	11746
Country	:	US
Telephone Number	:	631-847-0200
Fax Number	:	631-847-3525

Provider Business Practice Location Address
First Line	:	206 EAST JERICHO TURNPIKE
Second Line	:
City	:	HUNTINGTON STATION
State	:	NY
Zip	:	11746
Country	:	US
Telephone Number	:	631-847-0200
Fax Number	:	631-847-3525

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	03/19/2010

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