Healthcare Provider Details

I. General information

NPI: 1396116604
Provider Name (Legal Business Name): MARIEBELLE NOVAL ABELARDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5645 MAIN ST
FLUSHING NY
11355-5045
US

IV. Provider business mailing address

1059 NORTH 7TH STREET
NEW HYDE PARK NY
11040
US

V. Phone/Fax

Practice location:
  • Phone: 718-670-1080
  • Fax:
Mailing address:
  • Phone: 516-395-4532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number111482
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number589147-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number589147
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: