Provider Demographics
NPI:1568122646
Name:MARY ANN PESTRAK NP IN PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:MARY ANN PESTRAK NP IN PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PESTRAK
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:516-737-7018
Mailing Address - Street 1:3579 WYANET ST
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-3011
Mailing Address - Country:US
Mailing Address - Phone:718-316-8725
Mailing Address - Fax:516-331-3175
Practice Address - Street 1:3579 WYANET ST
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-3011
Practice Address - Country:US
Practice Address - Phone:516-737-7018
Practice Address - Fax:516-331-3175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty