Provider Demographics
NPI:1922166909
Name:CONLEY, MARY ELIZABETH (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:CONLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 HEMPSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-1201
Mailing Address - Country:US
Mailing Address - Phone:516-678-0076
Mailing Address - Fax:516-763-0981
Practice Address - Street 1:306 HEMPSTEAD AVE
Practice Address - Street 2:
Practice Address - City:MALVERNE
Practice Address - State:NY
Practice Address - Zip Code:11565-1201
Practice Address - Country:US
Practice Address - Phone:516-678-0076
Practice Address - Fax:516-763-0981
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330308363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
A400065273Medicare PIN