Healthcare Provider Details

I. General information

NPI: 1659646693
Provider Name (Legal Business Name): MARY BETH SNYDER PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152E83RD ST APT 2A
NEW YORK NY
10028-1938
US

IV. Provider business mailing address

152 E 83RD ST APT 2A
NEW YORK NY
10028-1938
US

V. Phone/Fax

Practice location:
  • Phone: 603-344-9481
  • Fax:
Mailing address:
  • Phone: 603-344-9481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF382223
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number004892
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: