Healthcare Provider Details

I. General information

NPI: 1083674998
Provider Name (Legal Business Name): MARY JOAN VACCARO-OLKO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 NORTH ST STE 302
WHITE PLAINS NY
10605
US

IV. Provider business mailing address

532 BROADHOLLOW RD STE 142
MELVILLE NY
11747-3623
US

V. Phone/Fax

Practice location:
  • Phone: 914-946-1406
  • Fax: 631-247-0029
Mailing address:
  • Phone: 516-931-0041
  • Fax: 516-822-1686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF333086
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: