Provider Demographics
NPI:1730524455
Name:FM MCLAUGHLIN MEDICAL PLLC
Entity type:Organization
Organization Name:FM MCLAUGHLIN MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:SEBASTIAN
Authorized Official - Last Name:MORA-MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-993-5093
Mailing Address - Street 1:2901 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-2638
Mailing Address - Country:US
Mailing Address - Phone:718-993-5093
Mailing Address - Fax:718-993-5099
Practice Address - Street 1:2901 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-2638
Practice Address - Country:US
Practice Address - Phone:718-993-5093
Practice Address - Fax:718-993-5099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212244174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02211434Medicaid
NYI04311Medicare UPIN