Provider Demographics
NPI:1477931970
Name:MCCARTHY, PATRICK JOHN I
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:JOHN
Last Name:MCCARTHY
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2633
Mailing Address - Country:US
Mailing Address - Phone:631-277-9283
Mailing Address - Fax:631-277-9394
Practice Address - Street 1:174 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2633
Practice Address - Country:US
Practice Address - Phone:631-277-9283
Practice Address - Fax:631-277-9394
Is Sole Proprietor?:No
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034594-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist