Healthcare Provider Details

I. General information

NPI: 1942288261
Provider Name (Legal Business Name): ALICE J LOONEY ANPBC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 DUBOIS ST
NEWBURGH NY
12550-4851
US

IV. Provider business mailing address

70 DUBOIS ST
NEWBURGH NY
12550-4851
US

V. Phone/Fax

Practice location:
  • Phone: 845-692-8087
  • Fax: 845-692-3439
Mailing address:
  • Phone: 845-692-8087
  • Fax: 845-692-3439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number303930
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: