Provider Demographics
NPI:1114902343
Name:CLAIN, DAVID J (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:CLAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32886
Mailing Address - Street 2:BETH ISRAEL MEDICAL CENTER, DEPT OF GASTROENTEROLOGY
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06150-2886
Mailing Address - Country:US
Mailing Address - Phone:212-420-4521
Mailing Address - Fax:212-420-4373
Practice Address - Street 1:10 UNION SQUARE E
Practice Address - Street 2:#2G, PHILLIPS AMBULATORY CARE CENTER
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3801
Practice Address - Country:US
Practice Address - Phone:212-420-4521
Practice Address - Fax:212-420-4373
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY138832207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00837132Medicaid
NY19D841Medicare ID - Type Unspecified
NY00837132Medicaid