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NPI Code Detail

MEDICARE: MARA ALEXIS MCCROSSIN NP

MEDICARE: MARA ALEXIS MCCROSSIN NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse Practitioner308239NY

General Provider Information

NPI Number : 1861920480
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARA ALEXIS MCCROSSIN NP
Provider Business Mailing Address
First Line : 751 HEMPSTEAD AVE
Second Line :
City : WEST HEMPSTEAD
State : NY
Zip : 11552-3230
Country : US
Telephone Number : 516-902-0213
Fax Number :
Provider Business Practice Location Address
First Line : 101 SAINT ANDREWS LN
Second Line :
City : GLEN COVE
State : NY
Zip : 11542-2263
Country : US
Telephone Number : 516-674-7300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2017
Last Update Date : 11/14/2021

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