Provider Demographics
NPI:1235319575
Name:VIGLIS, MARIKA (MED)
Entity Type:Individual
Prefix:
First Name:MARIKA
Middle Name:
Last Name:VIGLIS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2549 32ND ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-1743
Mailing Address - Country:US
Mailing Address - Phone:718-278-2956
Mailing Address - Fax:
Practice Address - Street 1:2549 32ND ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1743
Practice Address - Country:US
Practice Address - Phone:718-278-2956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-04
Last Update Date:2007-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001697-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health