Healthcare Provider Details

I. General information

NPI: 1821016734
Provider Name (Legal Business Name): MARIE GUOBADIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 OCEAN PKWY
BROOKLYN NY
11235-7745
US

IV. Provider business mailing address

PO BOX 365
UNIONDALE NY
11553
US

V. Phone/Fax

Practice location:
  • Phone: 716-616-4046
  • Fax: 718-616-4056
Mailing address:
  • Phone: 631-219-4979
  • Fax: 718-616-4056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number154018
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: