Healthcare Provider Details

I. General information

NPI: 1184663429
Provider Name (Legal Business Name): MARY ELIZABETH CAHILL NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 BUFFALO AVENUE
BROOKLYN NY
11233
US

IV. Provider business mailing address

58 BUFFALO AVENUE
BROOKLYN NY
11233
US

V. Phone/Fax

Practice location:
  • Phone: 718-221-5800
  • Fax: 718-221-5803
Mailing address:
  • Phone: 718-221-5800
  • Fax: 718-221-5803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF340595
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number304102
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: