Healthcare Provider Details

I. General information

NPI: 1073852802
Provider Name (Legal Business Name): HALLIE MCCAFFERTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 W 17TH ST
NEW YORK NY
10011-5325
US

IV. Provider business mailing address

230 W 17TH ST
NEW YORK NY
10011-5325
US

V. Phone/Fax

Practice location:
  • Phone: 212-206-5200
  • Fax: 212-206-5277
Mailing address:
  • Phone: 212-206-5200
  • Fax: 212-206-5277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number337780
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number402167
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: