Provider Demographics
NPI:1326111980
Name:MOLONEY, MAURA SUZANNE (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:MAURA
Middle Name:SUZANNE
Last Name:MOLONEY
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 HENRY HUDSON PKWY
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4733
Mailing Address - Country:US
Mailing Address - Phone:718-432-2893
Mailing Address - Fax:
Practice Address - Street 1:1515 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-5980
Practice Address - Country:US
Practice Address - Phone:718-860-8595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381072363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics