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General NPI Number Information
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NPI Number | 1407461676
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Entity Type | Individual
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Provider Name | KIM MARIE NEENAN-REILLY APRN
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Gender | Female
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Dates
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Enumeration Date | 09/14/2020
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Last Update Date | 09/14/2020
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Provider Practice Location Address
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Address Line | 7200 DOUGLASTON PKWY MAIN FLOOR
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City | DOUGLASTON
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State | NY
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Zip | 11362-1941
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Country | US
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Telephone | 718-461-3065
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Fax |
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Provider Business Mailing Address
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Address Line | 40 HARMON ST
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City | LONG BEACH
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State | NY
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Zip | 11561-2708
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Country | US
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Telephone | 516-351-1095
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 308746
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License Number State | NY
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