Provider Demographics
NPI:1013611631
Name:CALLAGHAN, MARIE CATHERINE (SPECIAL ED TEACHER)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:CATHERINE
Last Name:CALLAGHAN
Suffix:
Gender:F
Credentials:SPECIAL ED TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15011 87TH RD PH
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3311
Mailing Address - Country:US
Mailing Address - Phone:718-657-4025
Mailing Address - Fax:
Practice Address - Street 1:17730 WEXFORD TER
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-2924
Practice Address - Country:US
Practice Address - Phone:347-343-5261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY23783OtherNEW YORK STATE EI ID NUMBER