Healthcare Provider Details

I. General information

NPI: 1174020218
Provider Name (Legal Business Name): MARY LOUISE CARDELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 W 25TH ST
NEW YORK NY
10001-7207
US

IV. Provider business mailing address

448 STRAWTOWN RD
WEST NYACK NY
10994-1236
US

V. Phone/Fax

Practice location:
  • Phone: 212-533-3281
  • Fax: 212-343-8856
Mailing address:
  • Phone: 845-323-1294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number306658
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: