Provider Demographics
NPI:1497946503
Name:CARONE, MARY KAY (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARY KAY
Middle Name:
Last Name:CARONE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:200 OLD COUNTRY ROAD
Mailing Address - Street 2:DIALYSIS CENTER
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501
Mailing Address - Country:US
Mailing Address - Phone:516-663-9055
Mailing Address - Fax:516-663-9011
Practice Address - Street 1:200 OLD COUNTRY RD
Practice Address - Street 2:DIALYSIS CENTER
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4235
Practice Address - Country:US
Practice Address - Phone:516-663-9055
Practice Address - Fax:516-663-9011
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY302623363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ65508Medicare UPIN
NY1582G1Medicare PIN