Provider Demographics
NPI:1427502699
Name:MCPHERSON, MALCOLM
Entity type:Individual
Prefix:
First Name:MALCOLM
Middle Name:
Last Name:MCPHERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 CROPSEY AVE
Mailing Address - Street 2:AVENUE BROOKLYN
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-5706
Mailing Address - Country:US
Mailing Address - Phone:171-853-5901
Mailing Address - Fax:
Practice Address - Street 1:2340 CROPSEY AVE
Practice Address - Street 2:AVENUE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-5706
Practice Address - Country:US
Practice Address - Phone:718-535-9501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307925363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health