Healthcare Provider Details

I. General information

NPI: 1316324056
Provider Name (Legal Business Name): MARENN COLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2015
Last Update Date: 05/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 MOFFITT BLVD
ISLIP NY
11751-2915
US

IV. Provider business mailing address

241 MOFFITT BLVD
ISLIP NY
11751-2915
US

V. Phone/Fax

Practice location:
  • Phone: 631-766-7444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number636972
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WN0003X
TaxonomyLow-Risk Neonatal Registered Nurse
License Number636972
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License Number636972
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: