Healthcare Provider Details

I. General information

NPI: 1578602231
Provider Name (Legal Business Name): JAMES RAYMOND MCGAUGHAN JR. PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2157 TOMLINSON AVE
BRONX NY
10461-1267
US

IV. Provider business mailing address

306 WILLIAM AVE
BRONX NY
10464-1469
US

V. Phone/Fax

Practice location:
  • Phone: 718-794-2501
  • Fax: 718-794-2510
Mailing address:
  • Phone: 718-885-3619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number005092-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: