Provider Demographics
NPI:1235103342
Name:MCCARTHY, JOHN DOMINICK (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DOMINICK
Last Name:MCCARTHY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-4106
Mailing Address - Country:US
Mailing Address - Phone:718-668-9300
Mailing Address - Fax:718-668-1834
Practice Address - Street 1:1776 RICHMOND RD
Practice Address - Street 2:SUITE 5
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2581
Practice Address - Country:US
Practice Address - Phone:718-668-9300
Practice Address - Fax:718-668-1834
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211722208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02060699Medicaid
NY02060699Medicaid
NYH12572Medicare UPIN