Provider Demographics
NPI:1225350994
Name:MINEHAN, MARY (LPN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MINEHAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 CLOVER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WESTTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10998-3800
Mailing Address - Country:US
Mailing Address - Phone:845-726-4670
Mailing Address - Fax:
Practice Address - Street 1:99 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-6026
Practice Address - Country:US
Practice Address - Phone:845-357-4500
Practice Address - Fax:845-357-5039
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239852164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse