Provider Demographics
NPI:1124143490
Name:MARSH LANDING BEHAVIORAL GROUP INC
Entity type:Organization
Organization Name:MARSH LANDING BEHAVIORAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:TOMASKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-543-0161
Mailing Address - Street 1:1538 THE GREENS WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-2499
Mailing Address - Country:US
Mailing Address - Phone:904-543-0161
Mailing Address - Fax:904-543-9172
Practice Address - Street 1:1538 THE GREENS WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-2499
Practice Address - Country:US
Practice Address - Phone:904-543-0161
Practice Address - Fax:904-543-9172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty