Provider Demographics
NPI:1780662932
Name:MOLLOY, MARY GALAXIE (APRN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:GALAXIE
Last Name:MOLLOY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:424 TERHUNE AVE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-5746
Mailing Address - Country:US
Mailing Address - Phone:201-225-1562
Mailing Address - Fax:
Practice Address - Street 1:211 E 79TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-0819
Practice Address - Country:US
Practice Address - Phone:212-879-1600
Practice Address - Fax:212-988-3103
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340392363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY96V671Medicare ID - Type Unspecified