Healthcare Provider Details

I. General information

NPI: 1699790352
Provider Name (Legal Business Name): ELIZABETH MCSWEENEY CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 N MAIN ST
NEW SQUARE NY
10977-8916
US

IV. Provider business mailing address

10 CANTERBURY LN
SUFFERN NY
10901-3502
US

V. Phone/Fax

Practice location:
  • Phone: 845-354-9300
  • Fax: 845-354-9448
Mailing address:
  • Phone: 845-368-2736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF331214
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: