Mary Archer, MSED
Individual provider Active NPI Specialist · Bohemia, NY
NPI 1891042263 · NPPES record last updated Aug 5, 2012
Key facts
- NPI
- 1891042263
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- Practice address
- 788 Franklyn Ave
Bohemia, NY 11716-4402 - Phone
- (631) 567-3789
- NPI assigned
- Aug 5, 2012
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | Yes |
Addresses
Primary practice location
788 Franklyn Ave
Bohemia, NY 11716-4402
Mailing address
788 Franklyn Ave
Bohemia, NY 11716-4402
Other providers in Bohemia, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 5, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.