Provider Demographics
NPI:1689836058
Name:JAMES MCDONNELL INC
Entity Type:Organization
Organization Name:JAMES MCDONNELL INC
Other - Org Name:PEDIATRIC DENTISTRY OF CLIFTON PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGRATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-373-1181
Mailing Address - Street 1:532 MOE RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3822
Mailing Address - Country:US
Mailing Address - Phone:518-373-1181
Mailing Address - Fax:518-348-6517
Practice Address - Street 1:532 MOE RD
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3822
Practice Address - Country:US
Practice Address - Phone:518-373-1181
Practice Address - Fax:518-348-6517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY500488031223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02937002Medicaid
NY02145742Medicaid