Provider Demographics
NPI:1831542505
Name:O'LEARY, KATHRYN (PNP)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 34TH AVE
Mailing Address - Street 2:APT. 15A
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4362
Mailing Address - Country:US
Mailing Address - Phone:917-282-1270
Mailing Address - Fax:
Practice Address - Street 1:150 55TH STREET
Practice Address - Street 2:NYU LUTHERAN
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220
Practice Address - Country:US
Practice Address - Phone:718-630-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY382477363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics