Healthcare Provider Details

I. General information

NPI: 1295738136
Provider Name (Legal Business Name): JOHN MCCLUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADHURST AVE
HAWTHORNE NY
10532-2140
US

IV. Provider business mailing address

100 WOODS RD TCC ROOM D368
VALHALLA NY
10595-1530
US

V. Phone/Fax

Practice location:
  • Phone: 914-909-6900
  • Fax: 914-493-2828
Mailing address:
  • Phone: 914-493-7530
  • Fax: 914-493-5827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number1275841
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: