1174944987 NPI number — MRS. MARIANNE SKELLY M.S.

Table of content: MRS. MARIANNE SKELLY M.S. (NPI 1174944987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174944987 NPI number — MRS. MARIANNE SKELLY M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SKELLY
Provider First Name:
MARIANNE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ESPOSITO
Provider Other First Name:
MARIANNE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174944987
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 LODER ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORKTOWN HEIGHTS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10598
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-243-5214
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 CEDAR STREET
Provider Second Line Business Practice Location Address:
THERACARE
Provider Business Practice Location Address City Name:
NEW ROCHELLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-576-5292
Provider Business Practice Location Address Fax Number:
914-576-3983
Provider Enumeration Date:
12/20/2013

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: 174400000X , 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)