=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396369765
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIUSZ LIGOCKI M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2020
-----------------------------------------------------
Last Update Date | 07/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | HOSPITAL FOR SPECIAL SURGERY 535 EAST 70TH STREET
-----------------------------------------------------
City | NEW YORK CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-606-1206
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12201 LARCHMERE BLVD APT 202
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44120-1193
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-343-0005
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------