Provider Demographics
NPI:1598056509
Name:O'CONNOR, DAVID M (NP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:90 KIRKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-1436
Mailing Address - Country:US
Mailing Address - Phone:315-982-8673
Mailing Address - Fax:315-334-4267
Practice Address - Street 1:264 W DOMINICK ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-5812
Practice Address - Country:US
Practice Address - Phone:315-334-4701
Practice Address - Fax:315-334-4267
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2024-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY562923163WP0808X
NY402459363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health