Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 383163 | NY |
NPI | 1023615341 |
---|---|
Provider Name | Erin O'mahoney |
First Address | Northport, NY 11768-1205 |
Second Address | Huntington, NY 11743-2799 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2020 |
Last Update Date | 09/10/2020 |