Provider Demographics
NPI:1184825168
Name:MCCOURT, MARY P (PNP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:P
Last Name:MCCOURT
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:63 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-5430
Mailing Address - Country:US
Mailing Address - Phone:914-472-8407
Mailing Address - Fax:
Practice Address - Street 1:1400 PELHAM PARKWAY
Practice Address - Street 2:JACOBI MEDICAL CENTER
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:718-918-4910
Practice Address - Fax:718-918-4181
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF380175-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics