Healthcare Provider Details

I. General information

NPI: 1598737132
Provider Name (Legal Business Name): GUY S. ETIENNE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 11/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BROOKDALE PLZ
BROOKLYN NY
11212-3139
US

IV. Provider business mailing address

520 HALF HOLLOW RD
DIX HILLS NY
11746
US

V. Phone/Fax

Practice location:
  • Phone: 718-240-5978
  • Fax: 718-240-6610
Mailing address:
  • Phone: 631-455-8681
  • Fax: 631-424-0372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number142131
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number142131
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: