Healthcare Provider Details

I. General information

NPI: 1780948984
Provider Name (Legal Business Name): KEVIN GERARD PRYOR R.N. BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 07/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 MOUNT COOK AVE
FARMINGVILLE NY
11738-2022
US

IV. Provider business mailing address

7 MOUNT COOK AVE
FARMINGVILLE NY
11738-2022
US

V. Phone/Fax

Practice location:
  • Phone: 631-736-5603
  • Fax:
Mailing address:
  • Phone: 631-736-5603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number589840-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: