Provider Demographics
NPI:1003185109
Name:KISELEWSKY, MARY-ELLEN (RN)
Entity Type:Individual
Prefix:
First Name:MARY-ELLEN
Middle Name:
Last Name:KISELEWSKY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 MOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-1727
Mailing Address - Country:US
Mailing Address - Phone:631-491-4390
Mailing Address - Fax:631-662-4941
Practice Address - Street 1:550 MOUNT AVE
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-1727
Practice Address - Country:US
Practice Address - Phone:631-491-4390
Practice Address - Fax:631-662-4941
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195821163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool