Provider Demographics
NPI:1700156460
Name:O'SHAUGHNESSY, JANE (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:O'SHAUGHNESSY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W 89TH ST
Mailing Address - Street 2:APT 11A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1848
Mailing Address - Country:US
Mailing Address - Phone:212-873-5963
Mailing Address - Fax:
Practice Address - Street 1:201 W 89TH ST
Practice Address - Street 2:APT 11A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1848
Practice Address - Country:US
Practice Address - Phone:212-873-5963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122403207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine