Provider Demographics
NPI:1659646693
Name:SNYDER, MARY BETH (PNP)
Entity Type:Individual
Prefix:
First Name:MARY BETH
Middle Name:
Last Name:SNYDER
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 E 83RD ST
Mailing Address - Street 2:APT 2A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-1938
Mailing Address - Country:US
Mailing Address - Phone:603-344-9481
Mailing Address - Fax:
Practice Address - Street 1:152E83RD ST
Practice Address - Street 2:APT 2A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-1938
Practice Address - Country:US
Practice Address - Phone:603-344-9481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF382223363LP0200X
CT004892363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics