Healthcare Provider Details

I. General information

NPI: 1073703088
Provider Name (Legal Business Name): COLLEEN DEIDRE MCCARTHY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 96TH ST #2E
BROOKLYN NY
11209-7547
US

IV. Provider business mailing address

120 96TH ST #2E
BROOKLYN NY
11209-7547
US

V. Phone/Fax

Practice location:
  • Phone: 718-680-5643
  • Fax:
Mailing address:
  • Phone: 718-680-5643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number505975
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: