Basic Information
| Provider Information | |||||||||
| NPI: | 1568122646 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARY ANN PESTRAK NP IN PSYCHIATRY PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3579 WYANET ST | ||||||||
| Address2: | |||||||||
| City: | SEAFORD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117833011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183168725 | ||||||||
| FaxNumber: | 5163313175 | ||||||||
| Practice Location | |||||||||
| Address1: | 3579 WYANET ST | ||||||||
| Address2: | |||||||||
| City: | SEAFORD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117833011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167377018 | ||||||||
| FaxNumber: | 5163313175 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2021 | ||||||||
| LastUpdateDate: | 12/30/2021 | ||||||||
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| AuthorizedOfficialLastName: | PESTRAK | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | PSYCHIATRIC NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 5167377018 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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| AuthorizedOfficialCredential: | NP | ||||||||
| NPICertificationDate: | 12/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.