Provider Demographics
NPI:1861920480
Name:MCCROSSIN, MARA ALEXIS (NP)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:ALEXIS
Last Name:MCCROSSIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:MARA
Other - Middle Name:ALEXIS
Other - Last Name:FINKELMAN-MCCROSSIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:751 HEMPSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-3230
Mailing Address - Country:US
Mailing Address - Phone:516-902-0213
Mailing Address - Fax:
Practice Address - Street 1:101 SAINT ANDREWS LN
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2263
Practice Address - Country:US
Practice Address - Phone:516-674-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2021-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308239363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health