Provider Demographics
NPI:1760815658
Name:ZIEGELMAIER, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:ZIEGELMAIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:BERGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:57 WILLOUGHBY ST
Mailing Address - Street 2:HELEN KELLER 3RD FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5257
Mailing Address - Country:US
Mailing Address - Phone:718-522-2122
Mailing Address - Fax:
Practice Address - Street 1:57 WILLOUGHBY ST
Practice Address - Street 2:HELEN KELLER 3RD FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5257
Practice Address - Country:US
Practice Address - Phone:718-522-2122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY273915174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist