Provider Demographics
NPI:1942970850
Name:MCGINNESS, JOHN EDWARD
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARD
Last Name:MCGINNESS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BLACKBERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-3174
Mailing Address - Country:US
Mailing Address - Phone:914-556-8298
Mailing Address - Fax:914-556-8298
Practice Address - Street 1:290 9TH AVE APT 9F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5729
Practice Address - Country:US
Practice Address - Phone:212-989-2927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY483743252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency