Healthcare Provider Details

I. General information

NPI: 1811009657
Provider Name (Legal Business Name): SALLY A. MRAVCAK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 MONTGOMERY ST
JERSEY CITY NJ
07302-3616
US

IV. Provider business mailing address

271 GROVE AVE STE E
VERONA NJ
07044-1730
US

V. Phone/Fax

Practice location:
  • Phone: 201-431-7200
  • Fax: 833-488-1215
Mailing address:
  • Phone: 973-559-3700
  • Fax: 833-484-1686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA07499300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: