MEDICARE: DR. THOMAS JOSEPH CLEARY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0700X	Prosthodontics	028764	NY
2	1223P0700X	Prosthodontics	9320	NJ

General Provider Information

NPI Number	:	1760433130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS JOSEPH CLEARY DDS

Provider Business Mailing Address
First Line	:	100 ALBANY POST ROAD
Second Line	:
City	:	MONTROSE
State	:	NY
Zip	:	10548
Country	:	US
Telephone Number	:	914-737-4400
Fax Number	:

Provider Business Practice Location Address
First Line	:	FDR VA HOSPITAL
Second Line	:	ALBANY POST ROAD
City	:	MONTROSE
State	:	NY
Zip	:	10598-0100
Country	:	US
Telephone Number	:	914-737-4400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	07/08/2007

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