Healey Medical Practice, PLLC
Organization Active NPI Family Medicine Physician · Canton, NY
NPI 1457568792 · NPPES record last updated Oct 28, 2017
Key facts
- NPI
- 1457568792
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 214981 (NY)
- Legal business name
- HEALEY MEDICAL PRACTICE, PLLC
- Practice address
- 25 Park St
Canton, NY 13617-1265 - Phone
- (315) 379-9158
- Fax
- (315) 379-9604
- NPI assigned
- May 17, 2007
- Organization subpart
- No
Authorized official
- Name
- Gregory J Healey, MD
- Title
- Owner
- Phone
- (315) 379-9158
Practitioners 10
-
Gregory Healey, MD
-
Jordan Robert Fenton, FNP-C
-
Lindy L Chapman, PA-C
-
Alyssa N Moore, PA-C
-
Brooke Ann Baker, FNP
-
Sheryl Lynn Cruger, FNP
-
Nikita Glover, FNP
-
Alexandra Pesold, FNP
-
Amanda L Persons, PA-C
-
Denise Dunford, NP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080514000564 | NY | Part B Supplier - Clinic/Group Practice | 2668541806 |
Receives reassigned benefits from 9 practitioners Practice locations: Canton, NY; Potsdam, NY |
National Provider Directory
Locations
25 Park St
Canton, NY 13617
Phone (315) 379-9158
40 W Main St
Canton, NY 13617
Phone (315) 379-9158
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 214981 | NY | Yes |
Addresses
Primary practice location
25 Park St
Canton, NY 13617-1265
Mailing address
25 Park St
Canton, NY 13617-1265
Phone (315) 379-0404
Other providers in Canton, NY
- Nancy Linn Harrington
- Tracy Hart
- Andrea Hayden
- Amber Lee Haynes
- Ann Miriam Hazan
- Gregory Healey
- Tiffany Rose Hecht
- H M Chathuran Wikum Herath
- Michael Joseph Herzog
- Dina Marie Hierholzer
All providers in Canton, NY · Family Medicine Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 28, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.