Healthcare Provider Details

I. General information

NPI: 1235363953
Provider Name (Legal Business Name): MAUREEN TIERNEY MOYNIHAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2009
Last Update Date: 05/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 W 34TH ST
NEW YORK NY
10001-2321
US

IV. Provider business mailing address

58 JEFFERSON ST
GARDEN CITY NY
11530-3914
US

V. Phone/Fax

Practice location:
  • Phone: 212-695-3444
  • Fax: 212-695-0242
Mailing address:
  • Phone: 516-354-0192
  • Fax: 516-354-0860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number400960
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: