Healthcare Provider Details

I. General information

NPI: 1982841607
Provider Name (Legal Business Name): MARIE V NOEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2009
Last Update Date: 01/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 FREDERICK AVE
SOUTH FLORAL PARK NY
11001-3514
US

IV. Provider business mailing address

229 FREDERICK AVE
SOUTH FLORAL PARK NY
11001-3514
US

V. Phone/Fax

Practice location:
  • Phone: 516-352-2035
  • Fax:
Mailing address:
  • Phone: 516-352-2035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number208848
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: