Basic Information
Provider Information
NPI: 1770724551
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FINNERAN
FirstName: ANNE MARIE
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 20 GRAND STREET
Address2: 3RD FL
City: WARWICK
State: NY
PostalCode: 109901035
CountryCode: US
TelephoneNumber: 8459873906
FaxNumber: 8459875979
Practice Location
Address1: 10 FRANKLIN TPKE
Address2:  
City: MAHWAH
State: NJ
PostalCode: 074301304
CountryCode: US
TelephoneNumber: 2015290033
FaxNumber: 2015120542
Other Information
ProviderEnumerationDate: 03/09/2009
LastUpdateDate: 07/16/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X26NN06774200NJY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
363LF0000X5557296NYN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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