Healthcare Provider Details

I. General information

NPI: 1871878686
Provider Name (Legal Business Name): ST. MARKS PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 ST. MARKS PLACE
NEW YORK NY
10003
US

IV. Provider business mailing address

57 ST. MARKS PLACE
NEW YORK NY
10003
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 Code302R00000X
TaxonomyHealth Maintenance Organization
License Number9999999
License Number StateNY

VIII. Authorized Official

Name: MS. MONIKA MALGORZATA PEKALA-STEFANICK
Title or Position: INTERN/ PSYCHOTHERAPY
Credential: BA, MA
Phone: 908-720-9666