Provider Demographics
NPI:1861564262
Name:STRAKOSCH, MARY VIRGINIA (PNP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:VIRGINIA
Last Name:STRAKOSCH
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8 STOCKTON LN
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-3322
Mailing Address - Country:US
Mailing Address - Phone:631-751-1697
Mailing Address - Fax:631-675-6055
Practice Address - Street 1:150 E 45TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-3115
Practice Address - Country:US
Practice Address - Phone:212-949-4857
Practice Address - Fax:212-513-6022
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY380209363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000000087693OtherGHI HMO
NYPC4140OtherCENTER CARE
NY38020901OtherNEIGHBORHOOD HEALTH PROVI