Healthcare Provider Details

I. General information

NPI: 1669995940
Provider Name (Legal Business Name): KATHRYN RILEY PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

230 E 48TH ST APT 9D
NEW YORK NY
10017-1513
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-6443
  • Fax: 718-741-2150
Mailing address:
  • Phone: 845-926-7843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0218X
TaxonomyPediatric Oncology Registered Nurse
License Number689356
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number382925
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: