Healthcare Provider Details

I. General information

NPI: 1801873856
Provider Name (Legal Business Name): JAMES R. MCCLEAVEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 FRANKLIN AVE
HEWLETT NY
11557-1902
US

IV. Provider business mailing address

545 ELMONT RD
ELMONT NY
11003-4002
US

V. Phone/Fax

Practice location:
  • Phone: 516-295-5550
  • Fax: 516-569-8225
Mailing address:
  • Phone: 516-354-4200
  • Fax: 516-775-1972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME135779
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number146618
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: