Healthcare Provider Details

I. General information

NPI: 1073873717
Provider Name (Legal Business Name): MARIE E CAHILL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2012
Last Update Date: 05/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3304 93RD ST #1W
JACKSON HEIGHTS NY
11372-1941
US

IV. Provider business mailing address

3304 93RD ST #1W
JACKSON HEIGHTS NY
11372-1941
US

V. Phone/Fax

Practice location:
  • Phone: 718-335-4747
  • Fax: 718-476-2626
Mailing address:
  • Phone: 718-335-4747
  • Fax: 718-476-2626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number305969
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: