Healthcare Provider Details

I. General information

NPI: 1316282395
Provider Name (Legal Business Name): MARIEKETLER CAJUSTE M.S EDUCATION
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2012
Last Update Date: 12/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 MADISON AVENUE 2ND FLOOR YAI LIFESTART
NEW YORK NY
10017
US

IV. Provider business mailing address

401 W 25TH ST APT 13J
NEW YORK NY
10001-6576
US

V. Phone/Fax

Practice location:
  • Phone: 917-478-5865
  • Fax:
Mailing address:
  • Phone: 917-478-5865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1234698
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: