Provider Demographics
NPI:1023188349
Name:MCCALLION, ROBERT (ANP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MCCALLION
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3399
Mailing Address - Country:US
Mailing Address - Phone:631-424-3787
Mailing Address - Fax:631-427-0198
Practice Address - Street 1:175 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3399
Practice Address - Country:US
Practice Address - Phone:631-424-3787
Practice Address - Fax:631-427-0198
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3908761363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
S72136Medicare UPIN
NY98V241Medicare ID - Type Unspecified