MEDICARE: MARIE JOE PROSPERE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	344199	NY
2	164W00000X	Licensed Practical Nurse	344199	NY
3	163WG0000X	General Practice Registered Nurse	N16102	NY

General Provider Information

NPI Number	:	1831884907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE JOE PROSPERE

Provider Business Mailing Address
First Line	:	1453 E 70TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5711
Country	:	US
Telephone Number	:	347-771-2906
Fax Number	:

Provider Business Practice Location Address
First Line	:	1453 E 70TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5711
Country	:	US
Telephone Number	:	347-771-2906
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2023
Last Update Date	:	11/06/2025

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Directions to “ MARIE JOE PROSPERE ” Practice Location

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