Provider Demographics
NPI:1285741611
Name:CONNOLLY, VIRGINIA (APRN)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:
Other - Last Name:CONNOLLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:1 S GREELEY AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:CHAPPAQUA
Mailing Address - State:NY
Mailing Address - Zip Code:10514-3346
Mailing Address - Country:US
Mailing Address - Phone:914-238-1699
Mailing Address - Fax:914-238-1695
Practice Address - Street 1:1 S GREELEY AVE STE 302
Practice Address - Street 2:
Practice Address - City:CHAPPAQUA
Practice Address - State:NY
Practice Address - Zip Code:10514-3346
Practice Address - Country:US
Practice Address - Phone:914-238-1699
Practice Address - Fax:914-238-1695
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT062859163WP0809X, 163WP0808X, 163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTS47424Medicare UPIN