Healthcare Provider Details

I. General information

NPI: 1770823353
Provider Name (Legal Business Name): KATHLEEN ANN FOGARTY RN,NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2013
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E 77TH ST
NEW YORK NY
10075-1850
US

IV. Provider business mailing address

15 BROOK MNR
PLEASANTVILLE NY
10570-2415
US

V. Phone/Fax

Practice location:
  • Phone: 212-434-2565
  • Fax:
Mailing address:
  • Phone: 914-769-0982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberF350029-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: