1235986936 NPI number — MARY FRANK LCSW PSYCHOTHERAPY PLLC

Table of content: DR. ROSALINE EL KHOURY ISSA PHARMD (NPI 1154911972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235986936 NPI number — MARY FRANK LCSW PSYCHOTHERAPY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARY FRANK LCSW PSYCHOTHERAPY PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235986936
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
273 WALT WHITMAN RD UNIT 757
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON STATION
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11746-4149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-395-2935
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 WILDWOOD DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON STATION
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-395-2935
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/01/2024

Additional Information

Authorized Official

Authorized Official Last Name:
FRANK
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
516-395-2935

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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