Healthcare Provider Details

I. General information

NPI: 1336454610
Provider Name (Legal Business Name): CARYL ANN OREILLY CNS, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 LONGFELLOW AVE
STATEN ISLAND NY
10301-4615
US

IV. Provider business mailing address

1150 SOUTH AVE
STATEN ISLAND NY
10314-3404
US

V. Phone/Fax

Practice location:
  • Phone: 718-981-7765
  • Fax:
Mailing address:
  • Phone: 718-981-7765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number186603-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: