Provider Demographics
NPI:1578735437
Name:DOMINICAN CONVENT OF OUR LADY OF THE ROSARY
Entity Type:Organization
Organization Name:DOMINICAN CONVENT OF OUR LADY OF THE ROSARY
Other - Org Name:DOMINICAN HOLISTIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:ELEANOR
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:845-359-3311
Mailing Address - Street 1:175 ROUTE 340
Mailing Address - Street 2:MEDICAL OFFICE RM. 312
Mailing Address - City:SPARKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10976-1041
Mailing Address - Country:US
Mailing Address - Phone:845-359-3311
Mailing Address - Fax:845-325-9331
Practice Address - Street 1:175 ROUTE 340
Practice Address - Street 2:MEDICAL OFFICE RM. 312
Practice Address - City:SPARKILL
Practice Address - State:NY
Practice Address - Zip Code:10976-1041
Practice Address - Country:US
Practice Address - Phone:845-359-3311
Practice Address - Fax:845-325-9331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330016363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY94V521Medicare PIN