Provider Demographics
NPI:1619111010
Name:MARONEY, MARY VIRGINIA (RN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:VIRGINIA
Last Name:MARONEY
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 1:129 85TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4303
Mailing Address - Country:US
Mailing Address - Phone:917-364-3449
Mailing Address - Fax:866-374-7561
Practice Address - Street 1:1672 VICTORY BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3506
Practice Address - Country:US
Practice Address - Phone:718-720-7242
Practice Address - Fax:866-374-7561
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270978163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse