Provider Demographics
NPI:1932119526
Name:MCGINLEY, BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:MCGINLEY
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 1:635 BELLE TERRE RD
Mailing Address - Street 2:SUITE #204
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1935
Mailing Address - Country:US
Mailing Address - Phone:631-474-0008
Mailing Address - Fax:631-474-0224
Practice Address - Street 1:635 BELLE TERRE RD
Practice Address - Street 2:SUITE #204
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1935
Practice Address - Country:US
Practice Address - Phone:631-474-0008
Practice Address - Fax:631-474-0224
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202072-1207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY79G771Medicare ID - Type Unspecified
NYG68749Medicare UPIN