Individual
MARY DEVINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2201 HEMPSTEAD TPKE, INTERNAL BOX 42, EAST MEADOW, NY 11554-1859
(516) 572-6131
(516) 572-5793
Mailing address
59 JEFFERSON AVE, WYANDANCH, NY 11798-4021
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
006111
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006111
LICENSE NUMBER
NY
Enumeration date
12/13/2006
Last updated
07/08/2007
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