Provider Demographics
NPI:1053420299
Name:MC NALLY, LOIS MARIE (MD)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:MARIE
Last Name:MC NALLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 E 14TH ST
Mailing Address - Street 2:SUITE 319S
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4201
Mailing Address - Country:US
Mailing Address - Phone:212-979-4077
Mailing Address - Fax:212-979-4512
Practice Address - Street 1:310 E 14TH ST
Practice Address - Street 2:SUITE 319S
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4201
Practice Address - Country:US
Practice Address - Phone:212-979-4077
Practice Address - Fax:212-979-4512
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-10-07
Deactivation Date:2008-04-08
Deactivation Code:
Reactivation Date:2008-07-31
Provider Licenses
StateLicense IDTaxonomies
NY157559207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01256904Medicaid
NYE87564Medicare UPIN
NYA400000502Medicare PIN