Provider Demographics
NPI:1346450244
Name:LAMBERT, MARY TULLY (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:TULLY
Last Name:LAMBERT
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 1:2 RIDGEVIEW LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3012
Mailing Address - Country:US
Mailing Address - Phone:631-423-9013
Mailing Address - Fax:
Practice Address - Street 1:81 GRANDVIEW ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3536
Practice Address - Country:US
Practice Address - Phone:631-424-5759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY279322-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse