Healthcare Provider Details

I. General information

NPI: 1497999023
Provider Name (Legal Business Name): CATHERINE MARY OSULLIVAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 04/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82-68 164TH ST
JAMAICA NY
11432
US

IV. Provider business mailing address

79-01 BROADWAY MANAGED CARE, D1-01
ELMHURST NY
11373-1329
US

V. Phone/Fax

Practice location:
  • Phone: 718-883-3225
  • Fax: 718-883-6193
Mailing address:
  • Phone: 718-334-1921
  • Fax: 718-334-3432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number404700
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number333800
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: