Provider Demographics
NPI:1952487704
Name:SENNERT, MARY ELLEN (GNP)
Entity Type:Individual
Prefix:
First Name:MARY ELLEN
Middle Name:
Last Name:SENNERT
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 BLUE SPRUCE ROAD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-1500
Mailing Address - Country:US
Mailing Address - Phone:347-963-8973
Mailing Address - Fax:877-351-0599
Practice Address - Street 1:1 PENN PLZ
Practice Address - Street 2:SUITE 725
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10119-0002
Practice Address - Country:US
Practice Address - Phone:347-963-8973
Practice Address - Fax:877-351-0599
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340186363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02289747Medicaid
NY007121Medicare ID - Type Unspecified
NY02289747Medicaid