Provider Demographics
NPI:1649653270
Name:MCHALE, VIRGINIA
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:
Last Name:MCHALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:
Other - Last Name:NICHOLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6080 JERICHO TPKE
Mailing Address - Street 2:SUITE 314
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2850
Mailing Address - Country:US
Mailing Address - Phone:631-462-2200
Mailing Address - Fax:
Practice Address - Street 1:6080 JERICHO TPKE
Practice Address - Street 2:SUITE 314
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2850
Practice Address - Country:US
Practice Address - Phone:631-462-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF307329-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health