Healthcare Provider Details

I. General information

NPI: 1598056509
Provider Name (Legal Business Name): DAVID M O'CONNOR NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2011
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 W DOMINICK ST
ROME NY
13440-5812
US

IV. Provider business mailing address

90 KIRKLAND AVE
CLINTON NY
13323-1436
US

V. Phone/Fax

Practice location:
  • Phone: 315-334-4701
  • Fax: 315-334-4267
Mailing address:
  • Phone: 315-982-8673
  • Fax: 315-334-4267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number562923
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number402459
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: