Healthcare Provider Details

I. General information

NPI: 1891117487
Provider Name (Legal Business Name): METZIEMCCLARTY MCCLARTY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2014
Last Update Date: 01/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 AVENUE N
BROOKLYN NY
11236-5111
US

IV. Provider business mailing address

8501 AVENUE N
BROOKLYN NY
11236-5111
US

V. Phone/Fax

Practice location:
  • Phone: 718-451-2884
  • Fax:
Mailing address:
  • Phone: 718-451-2884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number471323
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: