Provider Demographics
NPI:1740381128
Name:CLANCY, PATRICK T (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:T
Last Name:CLANCY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:44 GODWIN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-1969
Mailing Address - Country:US
Mailing Address - Phone:201-447-5454
Mailing Address - Fax:201-447-8922
Practice Address - Street 1:44 GODWIN AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1969
Practice Address - Country:US
Practice Address - Phone:201-447-5454
Practice Address - Fax:201-447-8922
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04814800207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1003051003OtherCIGNA
NJ180037726OtherRR MEDICARE
NJ0578651OtherUNIVERSITY HEALTH PLANS
NJ160628OtherGREAT WEST/ONE HEALTH PLA
NJ0K5816OtherHEALTHNET
NJ500396OtherAETNA
NJP974388OtherOXFORD
NJ0578651OtherUNIVERSITY HEALTH PLANS
NJP974388OtherOXFORD