Provider Demographics
NPI:1114399052
Name:CLACHERTY, STEPHEN (RN)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:CLACHERTY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CHABLIS CT
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-2424
Mailing Address - Country:US
Mailing Address - Phone:631-626-2076
Mailing Address - Fax:
Practice Address - Street 1:60 CHARLES LINDBERGH BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-3653
Practice Address - Country:US
Practice Address - Phone:516-227-1499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296678163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health