Provider Demographics
NPI:1205076411
Name:PESTRAK, MARY ANN (APRN)
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:ANN
Last Name:PESTRAK
Suffix:
Gender:F
Credentials:APRN
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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:718-526-8400
Mailing Address - Fax:718-523-3063
Practice Address - Street 1:30 HEMPSTEAD AVE STE 154H
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4033
Practice Address - Country:US
Practice Address - Phone:516-737-7018
Practice Address - Fax:516-331-3175
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-27
Last Update Date:2021-09-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYF401181-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health