Healthcare Provider Details

I. General information

NPI: 1114805728
Provider Name (Legal Business Name): OCONNOR NP IN FAMILY HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 BEAVER POND RD
SOUTH SALEM NY
10590-2026
US

IV. Provider business mailing address

21 BEAVER POND RD
SOUTH SALEM NY
10590-2026
US

V. Phone/Fax

Practice location:
  • Phone: 914-775-9596
  • Fax:
Mailing address:
  • Phone: 914-775-9596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARIE OCONNOR
Title or Position: OWNER
Credential: NP
Phone: 914-775-9596