=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487526430
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IAN J MCDONALD
-----------------------------------------------------
Gender |
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2025
-----------------------------------------------------
Last Update Date | 09/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8431 VAN WYCK EXPY APT 3D
-----------------------------------------------------
City | BRIARWOOD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11435-2610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-776-8559
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8431 VAN WYCK EXPY APT 3D
-----------------------------------------------------
City | BRIARWOOD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11435-2610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------