Provider Demographics
NPI:1346243268
Name:MCCORD, ROBERT J (PA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:MCCORD
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:206 EAST JERICHO TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746
Mailing Address - Country:US
Mailing Address - Phone:631-847-0200
Mailing Address - Fax:631-847-3525
Practice Address - Street 1:206 EAST JERICHO TURNPIKE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746
Practice Address - Country:US
Practice Address - Phone:631-847-0200
Practice Address - Fax:631-847-3525
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002007-1363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY970014578OtherRAILROAD MEDICARE
NYP2586035OtherOXFORD
NYWEZ981Medicare PIN