Healthcare Provider Details

I. General information

NPI: 1639509763
Provider Name (Legal Business Name): MARIE GELIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2013
Last Update Date: 11/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 FORD DRIVE
MASSAPEQUA NY
11758
US

IV. Provider business mailing address

54 FORD DRIVE
MASSAPEQUA NY
11758
US

V. Phone/Fax

Practice location:
  • Phone: 718-528-3432
  • Fax:
Mailing address:
  • Phone: 718-528-3432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number314484
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: