Basic Information
| Provider Information | |||||||||
| NPI: | 1053468405 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILLIAM E MCCORMICK, MD, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 380 MONTAUK HWY | ||||||||
| Address2: | |||||||||
| City: | WEST ISLIP | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117954403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314225371 | ||||||||
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| Practice Location | |||||||||
| Address1: | 380 MONTAUK HWY | ||||||||
| Address2: | |||||||||
| City: | WEST ISLIP | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117954403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314225371 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2007 | ||||||||
| LastUpdateDate: | 01/20/2022 | ||||||||
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| AuthorizedOfficialLastName: | MCCORMICK | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6314225371 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 01/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | DC9279 | 01 | NY | MEDICARE RR | OTHER | WES021 | 01 | NY | PTAN | OTHER |