Healthcare Provider Details

I. General information

NPI: 1801306865
Provider Name (Legal Business Name): ELLEN KATHLEEN MARKEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 ROCKEFELLER PLZ RM 924E-4
NEW YORK NY
10112-0015
US

IV. Provider business mailing address

116 E 19TH ST APT 8
NEW YORK NY
10003-2130
US

V. Phone/Fax

Practice location:
  • Phone: 212-664-2322
  • Fax:
Mailing address:
  • Phone: 919-798-7510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number342194
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: