Provider Demographics
NPI:1760735732
Name:CONNELLY, DANA J (MS SP ED, MSED)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:J
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:MS SP ED, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9009 NORTHERN BLVD
Mailing Address - Street 2:201
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-1683
Mailing Address - Country:US
Mailing Address - Phone:917-254-6742
Mailing Address - Fax:
Practice Address - Street 1:9009 NORTHERN BLVD
Practice Address - Street 2:201
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-1683
Practice Address - Country:US
Practice Address - Phone:917-254-6742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist