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General NPI Number Information
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NPI Number | 1033628656
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Entity Type | Individual
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Provider Name | CHELSEA J. MCCLURE PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/26/2017
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Last Update Date | 04/26/2019
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Provider Practice Location Address
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Address Line | 85 S MAPLE AVE
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-4561
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Country | US
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Telephone | 201-445-2830
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Fax | 201-445-7471
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Provider Business Mailing Address
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Address Line | 85 S MAPLE AVE
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-4561
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Country | US
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Telephone | 201-445-2830
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Fax | 201-445-7471
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00454800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 25MP00454800
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License Number State | NJ
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