Healthcare Provider Details

I. General information

NPI: 1275701823
Provider Name (Legal Business Name): MARY ELLEN CASEY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2008
Last Update Date: 03/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6125 MARATHON PKWY
LITTLE NECK NY
11362-2042
US

IV. Provider business mailing address

6125 MARATHON PKWY
LITTLE NECK NY
11362-2042
US

V. Phone/Fax

Practice location:
  • Phone: 718-224-8060
  • Fax: 718-224-5914
Mailing address:
  • Phone: 718-224-8060
  • Fax: 718-224-5914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number334387
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: