Healthcare Provider Details

I. General information

NPI: 1578744066
Provider Name (Legal Business Name): MS. MARY SPATHAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 HUDSON ST
NEW YORK NY
10014-6114
US

IV. Provider business mailing address

534 HUDSON ST
NEW YORK NY
10014-6114
US

V. Phone/Fax

Practice location:
  • Phone: 646-486-1048
  • Fax:
Mailing address:
  • Phone: 646-486-1048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number043451
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: