Basic Information
| Provider Information | |||||||||
| NPI: | 1538582689 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAZDERNIK | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | KATHERINE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LCAT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 382 ATLANTIC AVE | ||||||||
| Address2: | #2 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112171703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9173706792 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1 HOYT ST | ||||||||
| Address2: | 7TH FLOOR | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112015809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188020666 | ||||||||
| FaxNumber: | 7188589493 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2014 | ||||||||
| LastUpdateDate: | 01/27/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 221700000X | 001300-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Art Therapist |
No ID Information.