Healthcare Provider Details

I. General information

NPI: 1942055918
Provider Name (Legal Business Name): MARY ELIZABETH KING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 FORT WASHINGTON AVE
NEW YORK NY
10032-3733
US

IV. Provider business mailing address

210 DENVER RD
PARAMUS NJ
07652-3207
US

V. Phone/Fax

Practice location:
  • Phone: 917-750-1716
  • Fax:
Mailing address:
  • Phone: 201-694-9046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number726094
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: