Healthcare Provider Details

I. General information

NPI: 1669776217
Provider Name (Legal Business Name): MARIE PENSE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2010
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 W 20TH ST STE 909
NEW YORK NY
10011-3715
US

IV. Provider business mailing address

37 W 20TH ST STE 909
NEW YORK NY
10011-3715
US

V. Phone/Fax

Practice location:
  • Phone: 212-362-7010
  • Fax: 212-362-7013
Mailing address:
  • Phone: 212-362-7010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number300000010000
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. NADIA GIANNOPOULOS
Title or Position: EXECUTIVE DIRECTOR
Credential: MSED,SBL,SDL
Phone: 212-362-7010