Provider Demographics
NPI:1659055598
Name:AHEARN, MICHELLE J
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:J
Last Name:AHEARN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 LEX AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-5922
Mailing Address - Country:US
Mailing Address - Phone:516-633-4186
Mailing Address - Fax:
Practice Address - Street 1:26 LEX AVE
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-5922
Practice Address - Country:US
Practice Address - Phone:516-633-4186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYKZJ8231347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle