Healthcare Provider Details

I. General information

NPI: 1609475326
Provider Name (Legal Business Name): REBECCA W MCLAREN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA A WHEALEN

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N DEAN ST
ENGLEWOOD NJ
07631-2807
US

IV. Provider business mailing address

30 N DEAN ST
ENGLEWOOD NJ
07631-2807
US

V. Phone/Fax

Practice location:
  • Phone: 201-431-0321
  • Fax: 212-287-7210
Mailing address:
  • Phone: 201-431-0321
  • Fax: 212-287-7210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00632900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number029680
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00632900
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number029680
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: