1629052972 NPI number — MRS. MAUREEN ANNE BOLLER DELANEY NPP

Table of content: MRS. MAUREEN ANNE BOLLER DELANEY NPP (NPI 1629052972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629052972 NPI number — MRS. MAUREEN ANNE BOLLER DELANEY NPP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOLLER DELANEY
Provider First Name:
MAUREEN
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NPP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629052972
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
314 FOSTER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAYVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11782-3153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-837-2551
Provider Business Mailing Address Fax Number:
718-565-8419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75-20 ASTORIA BLVD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON HEIGHTS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-888-6794
Provider Business Practice Location Address Fax Number:
718-565-8392
Provider Enumeration Date:
11/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  F400514 - 1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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