Basic Information
| Provider Information | |||||||||
| NPI: | 1386646743 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLEARY | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 22581 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100872581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104824795 | ||||||||
| FaxNumber: | 8565283117 | ||||||||
| Practice Location | |||||||||
| Address1: | 1203 LANGHORNE NEWTOWN RD | ||||||||
| Address2: | SUITE 125 | ||||||||
| City: | LANGHORNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190471209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157105610 | ||||||||
| FaxNumber: | 2157105625 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2005 | ||||||||
| LastUpdateDate: | 06/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD025916E | PA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0053034000 | 01 | PA | KEYSTONE IBC | OTHER | 1597065 | 01 | PA | GATEWAY | OTHER | 469138 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 30048668 | 01 | PA | KEYSTONE FIRST | OTHER | 4084477 | 01 | PA | AETNA | OTHER | P00699956 | 01 | PA | RAILROAD MEDICARE | OTHER | 0293671 | 01 | PA | CIGNA, PA | OTHER | 0010585980013 | 05 | PA | MEDICAID |