Provider Demographics
NPI:1740050970
Name:FOLEY, MICHAEL A (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:FOLEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 BENNETT RD UNIT 454
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-3273
Mailing Address - Country:US
Mailing Address - Phone:401-595-5993
Mailing Address - Fax:
Practice Address - Street 1:2 CROSFIELD AVE STE 422
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2212
Practice Address - Country:US
Practice Address - Phone:845-358-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031145363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty