Provider Demographics
NPI:1144342460
Name:DAVID A MCCUNE
Entity type:Organization
Organization Name:DAVID A MCCUNE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:YAEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-844-5653
Mailing Address - Street 1:15 ELLIS DR
Mailing Address - Street 2:
Mailing Address - City:DRYDEN
Mailing Address - State:NY
Mailing Address - Zip Code:13053-9630
Mailing Address - Country:US
Mailing Address - Phone:607-844-5653
Mailing Address - Fax:607-844-8361
Practice Address - Street 1:15 ELLIS DR
Practice Address - Street 2:
Practice Address - City:DRYDEN
Practice Address - State:NY
Practice Address - Zip Code:13053-9630
Practice Address - Country:US
Practice Address - Phone:607-844-5653
Practice Address - Fax:607-844-8361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02769753Medicaid
NYAA0915Medicare ID - Type Unspecified