Healthcare Provider Details

I. General information

NPI: 1295154730
Provider Name (Legal Business Name): MCKIRVEN CEUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 E ROUTE 59
NANUET NY
10954-2910
US

IV. Provider business mailing address

162 E ROUTE 59
NANUET NY
10954-2910
US

V. Phone/Fax

Practice location:
  • Phone: 845-579-2700
  • Fax: 845-259-1904
Mailing address:
  • Phone: 845-579-2700
  • Fax: 845-259-1904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number293059
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: