Provider Demographics
NPI:1114134657
Name:KIELY, MARY A (ANP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:A
Last Name:KIELY
Suffix:
Gender:F
Credentials:ANP
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Other - First Name:
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Mailing Address - Street 1:530 1ST AVE
Mailing Address - Street 2:HCC 14TH FLOOR ROOM 5
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6402
Mailing Address - Country:US
Mailing Address - Phone:212-263-0980
Mailing Address - Fax:212-263-0941
Practice Address - Street 1:530 1ST AVE
Practice Address - Street 2:HCC 14TH FLOOR ROOM 5
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-0980
Practice Address - Fax:212-263-0941
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY303105363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health