Provider Demographics
NPI:1174957435
Name:O'CONNOR-ANDERSON, JOSEPHINE R (MSED)
Entity type:Individual
Prefix:MRS
First Name:JOSEPHINE
Middle Name:R
Last Name:O'CONNOR-ANDERSON
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 LATHAM RD
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-1105
Mailing Address - Country:US
Mailing Address - Phone:516-279-9857
Mailing Address - Fax:
Practice Address - Street 1:322 LATHAM RD
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-1105
Practice Address - Country:US
Practice Address - Phone:516-279-9857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1898842174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist