Provider Demographics
NPI:1851745715
Name:VASH, MARY J (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:VASH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-2227
Mailing Address - Country:US
Mailing Address - Phone:518-274-2607
Mailing Address - Fax:
Practice Address - Street 1:1724 5TH AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-3541
Practice Address - Country:US
Practice Address - Phone:518-272-3918
Practice Address - Fax:518-272-6391
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY520609-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse