Provider Demographics
NPI:1801231337
Name:MOSTOVAYA, MARIANNA (MS ED)
Entity Type:Individual
Prefix:MS
First Name:MARIANNA
Middle Name:
Last Name:MOSTOVAYA
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11020-1122
Mailing Address - Country:US
Mailing Address - Phone:917-215-4487
Mailing Address - Fax:
Practice Address - Street 1:13411 KEW GARDENS RD
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1930
Practice Address - Country:US
Practice Address - Phone:171-844-1055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY868835174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist