Provider Demographics
NPI:1629351903
Name:FAMILY PRACTICE MCCLELLAN
Entity Type:Organization
Organization Name:FAMILY PRACTICE MCCLELLAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SITE MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:FUSELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:518-346-3222
Mailing Address - Street 1:600 MCCLELLAN ST
Mailing Address - Street 2:MSGR. KEANE PAVILLION
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304-1009
Mailing Address - Country:US
Mailing Address - Phone:518-346-3222
Mailing Address - Fax:518-346-2436
Practice Address - Street 1:600 MCCLELLAN ST
Practice Address - Street 2:MSGR. KEANE PAVILLION
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-1009
Practice Address - Country:US
Practice Address - Phone:518-346-3222
Practice Address - Fax:518-346-2436
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPITALCARE MEDICAL GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174880207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty