Healthcare Provider Details

I. General information

NPI: 1649212788
Provider Name (Legal Business Name): THERESA L MCLAUGHLIN P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 E 72ND ST
NEW YORK NY
10021-4099
US

IV. Provider business mailing address

523 E 72ND ST
NEW YORK NY
10021-4099
US

V. Phone/Fax

Practice location:
  • Phone: 212-606-1946
  • Fax: 212-472-1486
Mailing address:
  • Phone: 212-606-1946
  • Fax: 212-472-1486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number005842
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: