Healthcare Provider Details

I. General information

NPI: 1316192552
Provider Name (Legal Business Name): MARIE FLORENCE CELESTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 08/29/2020
Certification Date: 08/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 DEER PARK AVE STE 2
DEER PARK NY
11729-6624
US

IV. Provider business mailing address

6 MILLBROOK CT
DIX HILLS NY
11746-7900
US

V. Phone/Fax

Practice location:
  • Phone: 631-486-9402
  • Fax:
Mailing address:
  • Phone: 631-486-9402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number260716
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: