Healthcare Provider Details

I. General information

NPI: 1780662932
Provider Name (Legal Business Name): MARY GALAXIE MOLLOY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E 79TH ST
NEW YORK NY
10021-0819
US

IV. Provider business mailing address

424 TERHUNE AVE
PARAMUS NJ
07652-5746
US

V. Phone/Fax

Practice location:
  • Phone: 212-879-1600
  • Fax: 212-988-3103
Mailing address:
  • Phone: 201-225-1562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberF340392
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: