Provider Demographics
NPI:1942288261
Name:LOONEY, ALICE J (ANPBC)
Entity Type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:J
Last Name:LOONEY
Suffix:
Gender:F
Credentials:ANPBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 DUBOIS ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-4851
Mailing Address - Country:US
Mailing Address - Phone:845-692-8087
Mailing Address - Fax:845-692-3439
Practice Address - Street 1:70 DUBOIS ST
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-4851
Practice Address - Country:US
Practice Address - Phone:845-692-8087
Practice Address - Fax:845-692-3439
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303930363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY331160OtherNYS LICENSE NUMBER
Q73057Medicare UPIN
191861Medicare PIN