Provider Demographics
NPI:1508126228
Name:KIERNAN, ALAN JOSEPH (ANP)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:JOSEPH
Last Name:KIERNAN
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22157 MANOR RD
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:11427-2027
Mailing Address - Country:US
Mailing Address - Phone:718-464-6156
Mailing Address - Fax:
Practice Address - Street 1:600 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3802
Practice Address - Country:US
Practice Address - Phone:516-562-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305807-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health