Healthcare Provider Details

I. General information

NPI: 1518910975
Provider Name (Legal Business Name): GRACE HENNESSY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRACE O'LEARY M.D.

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 E 23RD ST 11M
NEW YORK NY
10010-5011
US

IV. Provider business mailing address

321 W 54TH ST APARTMENT 614
NEW YORK NY
10019-5165
US

V. Phone/Fax

Practice location:
  • Phone: 212-686-7500
  • Fax:
Mailing address:
  • Phone: 212-262-4804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number229548
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: