Provider Demographics
NPI:1083440325
Name:CALLAHAN, NINA ERIN (PA)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:ERIN
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 CATHERINE ST
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-1004
Mailing Address - Country:US
Mailing Address - Phone:631-896-8579
Mailing Address - Fax:
Practice Address - Street 1:211 CATHERINE ST
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-1004
Practice Address - Country:US
Practice Address - Phone:631-896-8579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical