Provider Demographics
NPI:1245282433
Name:FOSTER, MARY J (RN, CS, FNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:FOSTER
Suffix:
Gender:F
Credentials:RN, CS, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 SAINT JOSEPHS BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3230
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:
Practice Address - Street 1:200 MADISON AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-3218
Practice Address - Country:US
Practice Address - Phone:607-734-1581
Practice Address - Fax:607-734-0972
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331091363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01570456Medicaid
NYJ400081606Medicare PIN