Provider Demographics
NPI:1336492529
Name:OFFNER, CECILY S (NP)
Entity Type:Individual
Prefix:
First Name:CECILY
Middle Name:S
Last Name:OFFNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 WASHINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:NY
Mailing Address - Zip Code:11575-1845
Mailing Address - Country:US
Mailing Address - Phone:516-378-2000
Mailing Address - Fax:
Practice Address - Street 1:CEREBRAL PALSY ASSOCIATION OF NASSAU COUNTY
Practice Address - Street 2:280 WASHINGTON AVENUE
Practice Address - City:ROOSEVELT
Practice Address - State:NY
Practice Address - Zip Code:11575-1845
Practice Address - Country:US
Practice Address - Phone:516-378-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2019-10-21
Deactivation Date:2015-04-01
Deactivation Code:
Reactivation Date:2019-07-19
Provider Licenses
StateLicense IDTaxonomies
NY309223363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health