Organization
NY KETAMINE MEDICAL PRACTICE PLLC
Active
Other names
NY Ketamine Medical Practice
Organization subpart
No
Provider details
NPI number
Authorized official
MARINA MAHONEY (HEAD OF RCM)
(913) 213-1084
Entity
Organization
Contact information
Practice address
160 BROADWAY FL 16, NEW YORK, NY 10038-4207
(917) 261-7370
(917) 477-6421
Mailing address
PO BOX 32, WOODLAWN, TN 37191-0032
(917) 261-7370
(917) 477-6421
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
07/31/2025
Last updated
01/08/2026
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