Provider Demographics
NPI:1891843934
Name:MCCORMICK, PAUL CHRISTIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:CHRISTIAN
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 W 168TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3726
Mailing Address - Country:US
Mailing Address - Phone:212-305-7976
Mailing Address - Fax:212-342-6850
Practice Address - Street 1:710 W 168TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3726
Practice Address - Country:US
Practice Address - Phone:212-305-7976
Practice Address - Fax:212-342-6850
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154934207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01167046Medicaid
133116525OtherTAX ID #
NJ2508907Medicaid
NY39F191Medicare ID - Type Unspecified
NY01167046Medicaid
133116525OtherTAX ID #