Basic Information
| Provider Information | |||||||||
| NPI: | 1306011325 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COURTNEY | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MSN, NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5400 FIELDSTON RD | ||||||||
| Address2: | APT 62B | ||||||||
| City: | RIVERDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104712541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186017639 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 GUSTAVE L LEVY PL MSH 1458 | ||||||||
| Address2: | MOUNT SINAI MEDICAL CENTER | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122416500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2008 | ||||||||
| LastUpdateDate: | 04/30/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 335456 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.