Provider Demographics
NPI:1770834848
Name:O'MALLEY, GERARD (LPN)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:
Last Name:O'MALLEY
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 CAPE COD WAY
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-5405
Mailing Address - Country:US
Mailing Address - Phone:585-730-9571
Mailing Address - Fax:
Practice Address - Street 1:247 CAPE COD WAY
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-5405
Practice Address - Country:US
Practice Address - Phone:585-730-9571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229303164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse