Healthcare Provider Details

I. General information

NPI: 1467612812
Provider Name (Legal Business Name): MAUREEN FARRELL LONERGAN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5645 MAIN ST
FLUSHING NY
11355-5045
US

IV. Provider business mailing address

5645 MAIN ST
FLUSHING NY
11355-5045
US

V. Phone/Fax

Practice location:
  • Phone: 718-670-1415
  • Fax: 516-437-4167
Mailing address:
  • Phone: 718-670-1415
  • Fax: 516-437-4167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF304520-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: