Provider Demographics
NPI:1992132039
Name:PACHES, MARY
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:PACHES
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:PACHES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHYISCAL THERAPIST A
Mailing Address - Street 1:3244 31ST STREET
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106
Mailing Address - Country:US
Mailing Address - Phone:718-626-2699
Mailing Address - Fax:
Practice Address - Street 1:3244 31ST ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-2561
Practice Address - Country:US
Practice Address - Phone:718-626-2699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY66-007998174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist