Provider Demographics
NPI:1194181875
Name:ATLAGH, GEMMA MARY (RN)
Entity Type:Individual
Prefix:MRS
First Name:GEMMA
Middle Name:MARY
Last Name:ATLAGH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:GEMMA
Other - Middle Name:MARY
Other - Last Name:CORRIDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1620 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4306
Mailing Address - Country:US
Mailing Address - Phone:917-667-9199
Mailing Address - Fax:
Practice Address - Street 1:1620 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4306
Practice Address - Country:US
Practice Address - Phone:917-667-9199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY443991163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY305964882OtherDRIVERS LIC #