Provider Demographics
NPI:1184618068
Name:JAMES MCAVEY MD PC
Entity type:Organization
Organization Name:JAMES MCAVEY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLER OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCAVEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-666-9142
Mailing Address - Street 1:15 MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3100
Mailing Address - Country:US
Mailing Address - Phone:914-666-9142
Mailing Address - Fax:
Practice Address - Street 1:15 MOORE AVE
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3100
Practice Address - Country:US
Practice Address - Phone:914-666-9142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1292761207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00408993Medicaid
C04551Medicare UPIN
NY02A871Medicare ID - Type Unspecified