Healthcare Provider Details

I. General information

NPI: 1568122646
Provider Name (Legal Business Name): MARY ANN PESTRAK NP IN PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2021
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3579 WYANET ST
SEAFORD NY
11783-3011
US

IV. Provider business mailing address

3579 WYANET ST
SEAFORD NY
11783-3011
US

V. Phone/Fax

Practice location:
  • Phone: 516-737-7018
  • Fax: 516-331-3175
Mailing address:
  • Phone: 718-316-8725
  • Fax: 516-331-3175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MISS MARY ANN PESTRAK
Title or Position: PSYCHIATRIC NURSE PRACTITIONER
Credential: NP
Phone: 516-737-7018