Provider Demographics
NPI:1821233602
Name:KEPKA, MARIA (MPT)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:
Last Name:KEPKA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 10TH ST # 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4401
Mailing Address - Country:US
Mailing Address - Phone:646-256-9412
Mailing Address - Fax:
Practice Address - Street 1:70 HAVEMEYER ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-2151
Practice Address - Country:US
Practice Address - Phone:718-599-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029852174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist