Provider Demographics
NPI:1609241421
Name:MONAHAN, MARY (RN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:MONAHAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 BROADWAY
Mailing Address - Street 2:SUITE 608
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-3223
Mailing Address - Country:US
Mailing Address - Phone:516-724-2455
Mailing Address - Fax:
Practice Address - Street 1:580 BROADWAY
Practice Address - Street 2:SUITE 608
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-3223
Practice Address - Country:US
Practice Address - Phone:516-724-2455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY660099-1163WE0003X
CA95034742163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency