Provider Demographics
NPI:1871878686
Name:ST. MARKS PLACE
Entity type:Organization
Organization Name:ST. MARKS PLACE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERN/ PSYCHOTHERAPY
Authorized Official - Prefix:MS
Authorized Official - First Name:MONIKA
Authorized Official - Middle Name:MALGORZATA
Authorized Official - Last Name:PEKALA-STEFANICK
Authorized Official - Suffix:
Authorized Official - Credentials:BA, MA
Authorized Official - Phone:908-720-9666
Mailing Address - Street 1:57 ST. MARKS PLACE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003
Mailing Address - Country:US
Mailing Address - Phone:212-982-3470
Mailing Address - Fax:212-477-0521
Practice Address - Street 1:57 ST. MARKS PLACE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-982-3470
Practice Address - Fax:212-477-0521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9999999302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization