Provider Demographics
NPI:1790193357
Name:ADDESSI, MARY K
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:ADDESSI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 HAWKINS RD
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-1941
Mailing Address - Country:US
Mailing Address - Phone:631-384-3021
Mailing Address - Fax:
Practice Address - Street 1:521 HAWKINS RD
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-1941
Practice Address - Country:US
Practice Address - Phone:631-384-3021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist