Healthcare Provider Details

I. General information

NPI: 1467724948
Provider Name (Legal Business Name): JOSEPH A MARSEILLE FPMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOSEPH A MARSEILLE NP

II. Dates (important events)

Enumeration Date: 01/31/2012
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 W 15TH ST
DEER PARK NY
11729-6305
US

IV. Provider business mailing address

21 12TH AVE
HUNTINGTN STA NY
11746-2104
US

V. Phone/Fax

Practice location:
  • Phone: 631-988-2983
  • Fax: 631-761-3129
Mailing address:
  • Phone: 631-547-1830
  • Fax: 631-547-1830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number634215
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF405958-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: