Healthcare Provider Details

I. General information

NPI: 1154718690
Provider Name (Legal Business Name): MARIAN CHRISTINE GORE C.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIAN CHRISTINE SELIQUINI

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 MAIN ST
PEEKSKILL NY
10566-2913
US

IV. Provider business mailing address

PO BOX 5036
WHITE PLAINS NY
10602-5036
US

V. Phone/Fax

Practice location:
  • Phone: 914-734-8800
  • Fax: 845-745-9406
Mailing address:
  • Phone: 914-898-9421
  • Fax: 914-734-8786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number001679
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: