Basic Information
Provider Information
NPI: 1285028522
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COONEY
FirstName: HOLLY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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Mailing Information
Address1: 55 WATER ST
Address2: 2ND FLOOR CRED DEPT
City: NEW YORK
State: NY
PostalCode: 100410004
CountryCode: US
TelephoneNumber: 6466802888
FaxNumber: 5165425556
Practice Location
Address1: 70 CHARLES LINDBERGH BLVD.
Address2: SUITE 100
City: UNIONDALE
State: NY
PostalCode: 115533634
CountryCode: US
TelephoneNumber: 5164832020
FaxNumber: 5165601855
Other Information
ProviderEnumerationDate: 03/25/2015
LastUpdateDate: 02/25/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/25/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X338882NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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