Provider Demographics
NPI:1700022324
Name:OSTROWSKI, MARK (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:OSTROWSKI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 SUMMER ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5546
Mailing Address - Country:US
Mailing Address - Phone:203-967-4995
Mailing Address - Fax:203-357-9030
Practice Address - Street 1:999 SUMMER ST
Practice Address - Street 2:SUITE 200
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5546
Practice Address - Country:US
Practice Address - Phone:203-967-4995
Practice Address - Fax:203-357-9030
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-02
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002433103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT680001539Medicare PIN