Healthcare Provider Details

I. General information

NPI: 1780506857
Provider Name (Legal Business Name): PATRICK DAVID MCGRANE NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

463 FAIRVIEW AVE APT 2L
RIDGEWOOD NY
11385-1906
US

IV. Provider business mailing address

463 FAIRVIEW AVE APT 2L
RIDGEWOOD NY
11385-1906
US

V. Phone/Fax

Practice location:
  • Phone: 347-743-1319
  • Fax:
Mailing address:
  • Phone: 347-743-1319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number360619
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: