Healthcare Provider Details

I. General information

NPI: 1740050970
Provider Name (Legal Business Name): MICHAEL A FOLEY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CENTEROCK RD
WEST NYACK NY
10994-2214
US

IV. Provider business mailing address

40 BENNETT RD UNIT 454
ENGLEWOOD NJ
07631-3273
US

V. Phone/Fax

Practice location:
  • Phone: 845-425-0555
  • Fax: 845-953-3214
Mailing address:
  • Phone: 401-595-5993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number031145
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number031145
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: