Provider Demographics
NPI:1497789184
Name:HOULIHAN, JANET E (NP/PA)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:E
Last Name:HOULIHAN
Suffix:
Gender:F
Credentials:NP/PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1462 ERIE BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12305-1026
Mailing Address - Country:US
Mailing Address - Phone:518-243-1500
Mailing Address - Fax:
Practice Address - Street 1:1101 NOTT ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2425
Practice Address - Country:US
Practice Address - Phone:518-243-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231831163WG0000X
NY002769363AM0700X
NY300443363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000496509001OtherBLUE SHIELD
NY787905OtherMVP
NY050803000023OtherFIDELIS CARE
NY7599221OtherGHI-PPO
NY000000069211OtherGHI-HMO
NYCC4259Medicare ID - Type Unspecified
NY787905OtherMVP