Healthcare Provider Details

I. General information

NPI: 1932349511
Provider Name (Legal Business Name): ST. MARY'S CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 02/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 W 126TH ST
NEW YORK NY
10027-2406
US

IV. Provider business mailing address

512 W 126TH ST
NEW YORK NY
10027-2406
US

V. Phone/Fax

Practice location:
  • Phone: 212-665-5992
  • Fax: 646-619-6272
Mailing address:
  • Phone: 212-665-5992
  • Fax: 646-619-6272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HOLLY A TARIQ
Title or Position: CEO
Credential:
Phone: 212-665-5992