Provider Demographics
NPI:1477946945
Name:TIMONEY, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:TIMONEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BULL RUN
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994
Mailing Address - Country:US
Mailing Address - Phone:646-220-4668
Mailing Address - Fax:
Practice Address - Street 1:4 BULL RUN
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2104
Practice Address - Country:US
Practice Address - Phone:646-220-4668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY511271163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse