Organization
SEALIGHT COALITION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIAM GARUBA M.D. (FOUNDER)
(973) 908-5642
Entity
Organization
Contact information
Practice address
26 COURT ST, 2011, BROOKLYN, NY 11242-0103
(718) 624-3192
Mailing address
26 COURT ST, BROOKLYN, NY 11242-0103
(718) 624-3192
Taxonomy
Speciality
Code
Description
License number
State
103TP0016X
Prescribing (Medical) Psychologist
Primary
268153
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1275748261
NPI
—
Enumeration date
03/30/2016
Last updated
03/30/2016
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