Provider Demographics
NPI:1265614705
Name:ORVILLE W MCLENAN MD PC
Entity type:Organization
Organization Name:ORVILLE W MCLENAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ORVILLE
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCLENAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-378-0123
Mailing Address - Street 1:294 W MERRICK RD
Mailing Address - Street 2:#2
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3374
Mailing Address - Country:US
Mailing Address - Phone:516-378-0123
Mailing Address - Fax:516-378-0148
Practice Address - Street 1:294 W MERRICK RD
Practice Address - Street 2:#2
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3374
Practice Address - Country:US
Practice Address - Phone:516-378-0123
Practice Address - Fax:516-378-0148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199719-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG99258Medicare UPIN
NYWRA921Medicare PIN