Provider Demographics
NPI:1124615000
Name:MCCLOSKEY, BRIAN C (ATC, LAT, CEAS II)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:C
Last Name:MCCLOSKEY
Suffix:
Gender:M
Credentials:ATC, LAT, CEAS II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:986 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-4552
Mailing Address - Country:US
Mailing Address - Phone:610-322-9176
Mailing Address - Fax:
Practice Address - Street 1:986 MAIN ST
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-4552
Practice Address - Country:US
Practice Address - Phone:610-322-9176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT002702002255A2300X
PART002070A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty