Healthcare Provider Details

I. General information

NPI: 1396783049
Provider Name (Legal Business Name): ST. MARK'S PLACE INSTITUTE FOR MENTAL HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 SAINT MARKS PL
NEW YORK NY
10003-7902
US

IV. Provider business mailing address

57 SAINT MARKS PL
NEW YORK NY
10003-7902
US

V. Phone/Fax

Practice location:
  • Phone: 212-982-3470
  • Fax: 212-477-0521
Mailing address:
  • Phone: 212-982-3470
  • Fax: 212-477-0521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number7574100A
License Number StateNY

VIII. Authorized Official

Name: ROMAN PABIS
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 212-982-3470