1194864470 NPI number — MRS. RITA MONICA O'NEILL FNP-C

Table of content: MRS. RITA MONICA O'NEILL FNP-C (NPI 1194864470)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194864470 NPI number — MRS. RITA MONICA O'NEILL FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'NEILL
Provider First Name:
RITA
Provider Middle Name:
MONICA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WATT
Provider Other First Name:
RITA
Provider Other Middle Name:
MONICA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194864470
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
427 GUY PARK AVE - PRIMARY & SPECIALTY CARE DEPT.
Provider Second Line Business Mailing Address:
ST. MARY'S HOSPITAL @ AMSTERDAM
Provider Business Mailing Address City Name:
AMSTERDAM
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-841-7430
Provider Business Mailing Address Fax Number:
518-841-7121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
48 ERIE BLVD
Provider Second Line Business Practice Location Address:
ST. MARY'S HOSPITAL, CANAJONARIE FAMILY HEALTH CENTER
Provider Business Practice Location Address City Name:
CANAJONARIE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-673-2573
Provider Business Practice Location Address Fax Number:
518-673-2781
Provider Enumeration Date:
02/05/2007

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: 363LF0000X , with the licence number:  335081 , 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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