Provider Demographics
NPI:1528352325
Name:CONNOLLY, ROBIN (FNP)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3203
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303-0203
Mailing Address - Country:US
Mailing Address - Phone:518-346-3100
Mailing Address - Fax:518-688-1342
Practice Address - Street 1:PO BOX 154
Practice Address - Street 2:
Practice Address - City:VALLEY FALLS
Practice Address - State:NY
Practice Address - Zip Code:12185-0154
Practice Address - Country:US
Practice Address - Phone:518-346-3100
Practice Address - Fax:518-688-1342
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336762363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ300053652OtherMEDICARE PTAN
NY03359928OtherMEDICAID UID