| Healey Medical Practice, Pllc | |
|
25 Park St Canton NY 13617-1265 | |
| (315) 379-9158 | |
| (315) 379-9604 |
| Full Name | Healey Medical Practice, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 25 Park St, Canton, New York |
| Authorized Official Name and Position | Gregory J Healey (OWNER) |
| Authorized Official Contact | 3153799158 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healey Medical Practice, Pllc 25 Park St Canton NY 13617-1265 Ph: (315) 379-0404 | Healey Medical Practice, Pllc 25 Park St Canton NY 13617-1265 Ph: (315) 379-9158 |
| NPI Number | 1457568792 |
|---|---|
| Provider Enumeration Date | 05/17/2007 |
| Last Update Date | 10/28/2017 |
| Medicare PECOS PAC ID | 2668541806 |
|---|---|
| Medicare Enrollment ID | O20080514000564 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457568792 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 214981 (New York) | Primary |
| Provider Name | Gregory J Healey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558372086 PECOS PAC ID: 2860470192 Enrollment ID: I20050331000883 |
| Provider Name | Sheryl L Cruger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699985952 PECOS PAC ID: 9739222936 Enrollment ID: I20100211000010 |
| Provider Name | Nikita D Goliber |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972985612 PECOS PAC ID: 8325338775 Enrollment ID: I20160526001357 |
| Provider Name | Jordan R Woodside |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912491374 PECOS PAC ID: 1355698929 Enrollment ID: I20180727002407 |
| Provider Name | Brooke A Baker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174165807 PECOS PAC ID: 0345673554 Enrollment ID: I20191202001768 |
| Provider Name | Alexandra K Pesold |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679204200 PECOS PAC ID: 9830573898 Enrollment ID: I20220825001784 |
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