Healthcare Provider Details

I. General information

NPI: 1851715650
Provider Name (Legal Business Name): TRISHA CARMEL FLEARY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W 57TH ST
NEW YORK NY
10019-2902
US

IV. Provider business mailing address

125 E 49TH ST
BROOKLYN NY
11203-1914
US

V. Phone/Fax

Practice location:
  • Phone: 212-293-3000
  • Fax:
Mailing address:
  • Phone: 718-514-5395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number680695
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: