Provider Demographics
NPI:1780900381
Name:GEORGE, MARY (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2424
Mailing Address - Country:US
Mailing Address - Phone:516-848-1280
Mailing Address - Fax:516-848-1280
Practice Address - Street 1:15011 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3319
Practice Address - Country:US
Practice Address - Phone:718-739-5778
Practice Address - Fax:718-523-2728
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY344864-1163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult