Provider Demographics
NPI:1184081077
Name:GERMAIN, MARY (EDD,ANP-BC,FNAP)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:GERMAIN
Suffix:
Gender:F
Credentials:EDD,ANP-BC,FNAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 CLARKSON AVE
Mailing Address - Street 2:BOX 22
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2012
Mailing Address - Country:US
Mailing Address - Phone:718-270-7607
Mailing Address - Fax:718-270-7628
Practice Address - Street 1:15 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08553-1029
Practice Address - Country:US
Practice Address - Phone:609-430-1945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN03172300363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health