Healthcare Provider Details

I. General information

NPI: 1396978334
Provider Name (Legal Business Name): MARY H MCENERNEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 08/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 W 27TH ST A402
NEW YORK NY
10001-5902
US

IV. Provider business mailing address

227 W 27TH ST A402
NEW YORK NY
10001-5902
US

V. Phone/Fax

Practice location:
  • Phone: 212-217-4190
  • Fax: 212-217-4191
Mailing address:
  • Phone: 212-217-4190
  • Fax: 212-217-4191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number331808
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9256273
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: