Healthcare Provider Details

I. General information

NPI: 1639001738
Provider Name (Legal Business Name): MARIE SONIA MYRTIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 CLARKSON AVE
BROOKLYN NY
11203-2054
US

IV. Provider business mailing address

1553 OCEAN AVE APT 2B
BROOKLYN NY
11230-3947
US

V. Phone/Fax

Practice location:
  • Phone: 347-995-9793
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number359639
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: