Healthcare Provider Details

I. General information

NPI: 1306093836
Provider Name (Legal Business Name): MARYANN SKOBLICKI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 CIRCLE DR W
EAST PATCHOGUE NY
11772-4294
US

IV. Provider business mailing address

92 CIRCLE DR W
EAST PATCHOGUE NY
11772-4294
US

V. Phone/Fax

Practice location:
  • Phone: 631-289-3626
  • Fax:
Mailing address:
  • Phone: 631-289-3626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number278790
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: