Basic Information
Provider Information | |||||||||
NPI: | 1609936046 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GEARY | ||||||||
FirstName: | MAUREEN | ||||||||
MiddleName: | C | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | ANP-BC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | FENSTERMAKER | ||||||||
OtherFirstName: | MAUREEN | ||||||||
OtherMiddleName: | C | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | ANP-BC | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 530 FIRST AVE | ||||||||
Address2: | NYU LANGONE MEDICAL CENTER | ||||||||
City: | NEW YORK | ||||||||
State: | NY | ||||||||
PostalCode: | 10016 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6465010119 | ||||||||
FaxNumber: | 6465010145 | ||||||||
Practice Location | |||||||||
Address1: | 530 FIRST AVE | ||||||||
Address2: | NYU LANGONE MEDICAL CENTER | ||||||||
City: | NEW YORK | ||||||||
State: | NY | ||||||||
PostalCode: | 10016 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6465010119 | ||||||||
FaxNumber: | 6465010145 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/08/2006 | ||||||||
LastUpdateDate: | 03/11/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/11/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | F304088 | NY | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
ID | Type | State | Issuer | Description | 02620579 | 05 | NY |   | MEDICAID |