Healthcare Provider Details

I. General information

NPI: 1174599682
Provider Name (Legal Business Name): MARISE ST. CHARLES D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 S CENTRAL AVE STE 205
HARTSDALE NY
10530-2340
US

IV. Provider business mailing address

141 S CENTRAL AVE STE 205
HARTSDALE NY
10530-2340
US

V. Phone/Fax

Practice location:
  • Phone: 914-793-5588
  • Fax:
Mailing address:
  • Phone: 914-793-5588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number257178
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: