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General NPI Number Information
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NPI Number | 1760252936
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Entity Type | Individual
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Provider Name | NIALL J O'CONNOR
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Gender | Male
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Dates
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Enumeration Date | 01/08/2024
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Last Update Date | 01/08/2024
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Provider Practice Location Address
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Address Line | 111 E 210TH ST
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City | BRONX
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State | NY
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Zip | 10467-2401
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Country | US
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Telephone | 718-920-4411
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Fax |
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Provider Business Mailing Address
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Address Line | 103 E PARK AVE
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City | PEARL RIVER
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State | NY
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Zip | 10965-2527
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Country | US
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Telephone |
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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 | 352510
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 708935
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License Number State | NY
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