Healthcare Provider Details

I. General information

NPI: 1114902343
Provider Name (Legal Business Name): DAVID J CLAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 UNION SQUARE E #2G, PHILLIPS AMBULATORY CARE CENTER
NEW YORK NY
10003-3801
US

IV. Provider business mailing address

PO BOX 32886 BETH ISRAEL MEDICAL CENTER, DEPT OF GASTROENTEROLOGY
HARTFORD CT
06150-2886
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-4521
  • Fax: 212-420-4373
Mailing address:
  • Phone: 212-420-4521
  • Fax: 212-420-4373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number138832
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: