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General NPI Number Information
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NPI Number | 1255865499
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Entity Type | Organization
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Legal Business Name | CLANCY NP ADULT HEALTH PC
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Dates
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Enumeration Date | 04/14/2017
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Last Update Date | 04/14/2017
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Provider Practice Location Address
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Address Line | 337 LENOX AVE
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City | NEW YORK
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State | NY
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Zip | 10027-3703
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Country | US
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Telephone | 646-707-3930
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Fax |
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Provider Business Mailing Address
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Address Line | 285 AVENUE C APT 10C
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City | NEW YORK
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State | NY
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Zip | 10009-2301
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Country | US
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Telephone | 516-356-1785
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS PHELAN CLANCY
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Credential |
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Telephone | 516-356-1785
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 6573601
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License Number State | NY
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