Healthcare Provider Details

I. General information

NPI: 1457038473
Provider Name (Legal Business Name): MARY KATE VISNIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 WHITNEY AVE STE 380
HAMDEN CT
06518-3602
US

IV. Provider business mailing address

ANESTHESIOLOGY DEPARTMENT OF MOUNT SINAI PO BOX 5024
NEW YORK NY
10087
US

V. Phone/Fax

Practice location:
  • Phone: 203-535-9031
  • Fax:
Mailing address:
  • Phone: 800-627-4470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number813979
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number142733
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: