Provider Demographics
NPI:1548281025
Name:MCCLINTOCK, BRIAN KEITH (MA)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:KEITH
Last Name:MCCLINTOCK
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:390 AMWELL RD
Mailing Address - Street 2:SUITE 407
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-1225
Mailing Address - Country:US
Mailing Address - Phone:908-431-4224
Mailing Address - Fax:908-431-4225
Practice Address - Street 1:390 AMWELL RD
Practice Address - Street 2:SUITE 407
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-1225
Practice Address - Country:US
Practice Address - Phone:908-431-4224
Practice Address - Fax:908-431-4225
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00065300237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0044156Medicaid
NJ0044156Medicaid