Provider Demographics
NPI:1467718841
Name:SWICICKI, MARY M (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:SWICICKI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:M
Other - Last Name:CORRIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:475 E MAIN ST
Mailing Address - Street 2:1ST FLOOR, SUITE 101
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3121
Mailing Address - Country:US
Mailing Address - Phone:631-363-2001
Mailing Address - Fax:631-363-2017
Practice Address - Street 1:475 E MAIN ST
Practice Address - Street 2:1ST FLOOR, SUITE 101
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3121
Practice Address - Country:US
Practice Address - Phone:631-363-2001
Practice Address - Fax:631-363-2017
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY456956163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse