Provider Demographics
NPI:1114129962
Name:MCBRIDE, MAUREEN (RN)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:MCBRIDE
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 1:21 ERVING AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-5534
Mailing Address - Country:US
Mailing Address - Phone:631-475-5948
Mailing Address - Fax:
Practice Address - Street 1:EAST END CLINIC
Practice Address - Street 2:300 CENTER DRIVE
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-0000
Practice Address - Country:US
Practice Address - Phone:631-852-2680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288221-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse