Healthcare Provider Details

I. General information

NPI: 1255682712
Provider Name (Legal Business Name): MRS. MARIE MAYE JOSEPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2012
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PENN PLAZA, 8TH FLOOR
NEW YORK NY
10119
US

IV. Provider business mailing address

1860 VIRGINIA AVE
ELMONT NY
11003-4919
US

V. Phone/Fax

Practice location:
  • Phone: 646-398-0036
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberF305632-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: