Healthcare Provider Details

I. General information

NPI: 1659674919
Provider Name (Legal Business Name): MISS JANE M HEALY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 E 90TH ST APT 4C
NEW YORK NY
10128-3540
US

IV. Provider business mailing address

246 E 90TH ST APT 4C
NEW YORK NY
10128-3540
US

V. Phone/Fax

Practice location:
  • Phone: 917-566-8724
  • Fax:
Mailing address:
  • Phone: 917-566-8724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number976955001
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: