Provider Demographics
NPI:1043544943
Name:MCTAGGART, MARIA ELENA (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:ELENA
Last Name:MCTAGGART
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 E 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07203-2214
Mailing Address - Country:US
Mailing Address - Phone:973-943-8339
Mailing Address - Fax:
Practice Address - Street 1:130 ROSE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2241
Practice Address - Country:US
Practice Address - Phone:718-980-1553
Practice Address - Fax:877-669-6967
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305156282N00000X
NY305156363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No282N00000XHospitalsGeneral Acute Care Hospital