Provider Demographics
NPI:1831240712
Name:O'HARA, EILEEN
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:O'HARA
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 1:1 PENN PLAZA 8TH FLOOR
Mailing Address - Street 2:OPTUM
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10119
Mailing Address - Country:US
Mailing Address - Phone:212-216-6652
Mailing Address - Fax:855-453-0909
Practice Address - Street 1:1 PENN PLZ
Practice Address - Street 2:8TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10119-0002
Practice Address - Country:US
Practice Address - Phone:212-216-6652
Practice Address - Fax:855-453-0909
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340470363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology