Provider Demographics
NPI:1184784316
Name:BRETT MOHYLA, MAUREEN (NP CNM)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:
Last Name:BRETT MOHYLA
Suffix:
Gender:F
Credentials:NP CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 ORCHARD ST
Mailing Address - Street 2:PO BOX 987
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-5004
Mailing Address - Country:US
Mailing Address - Phone:845-343-7614
Mailing Address - Fax:845-343-5390
Practice Address - Street 1:10 BENTON AVENUE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940
Practice Address - Country:US
Practice Address - Phone:845-343-7614
Practice Address - Fax:845-343-5390
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420572207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355931Medicaid
NYW04883Medicare ID - Type UnspecifiedPB
NY00355931Medicaid