Provider Demographics
NPI:1720700271
Name:NELLIGAN, MARY ELIZABETH (NYS-LMT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:NELLIGAN
Suffix:
Gender:F
Credentials:NYS-LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MCKOWN RD STE 202
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-3496
Mailing Address - Country:US
Mailing Address - Phone:518-350-6064
Mailing Address - Fax:
Practice Address - Street 1:10 MCKOWN RD STE 202
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3496
Practice Address - Country:US
Practice Address - Phone:518-350-6064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028914225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist