Provider Demographics
NPI:1336593052
Name:TOBIN, MARY CLARE
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CLARE
Last Name:TOBIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 SANITA RD
Mailing Address - Street 2:UNIT 3
Mailing Address - City:HOLMES
Mailing Address - State:NY
Mailing Address - Zip Code:12531-5468
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13 SANITA RD
Practice Address - Street 2:UNIT 3
Practice Address - City:HOLMES
Practice Address - State:NY
Practice Address - Zip Code:12531-5468
Practice Address - Country:US
Practice Address - Phone:845-416-8664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY276417164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse