Provider Demographics
NPI:1699190892
Name:SEWATSKY, MARY LAURA (MS, RN, CPNP)
Entity Type:Individual
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First Name:MARY LAURA
Middle Name:
Last Name:SEWATSKY
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Gender:F
Credentials:MS, RN, CPNP
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Mailing Address - Street 1:180 FORT WASHINGTON AVE
Mailing Address - Street 2:SUITE 199
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3722
Mailing Address - Country:US
Mailing Address - Phone:212-305-3535
Mailing Address - Fax:212-342-1470
Practice Address - Street 1:180 FORT WASHINGTON AVE
Practice Address - Street 2:SUITE 199
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3722
Practice Address - Country:US
Practice Address - Phone:212-305-3535
Practice Address - Fax:212-342-1470
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY382387363LA2200X, 363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWXVTR1Medicare PIN