Healthcare Provider Details

I. General information

NPI: 1487667242
Provider Name (Legal Business Name): KATHLEEN M. FAHEY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST MAP 4 DEPT OF SURGERY
BRONX NY
10467-2401
US

IV. Provider business mailing address

73 CATALPA PL
BRONX NY
10465-3808
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-5961
  • Fax: 718-798-1883
Mailing address:
  • Phone: 718-823-7716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number4342851
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: