Healthcare Provider Details

I. General information

NPI: 1285020842
Provider Name (Legal Business Name): MARINA FEST NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 SEAVIEW AVE
STATEN ISLAND NY
10305-3401
US

IV. Provider business mailing address

97 NEW DORP LN STE A
STATEN ISLAND NY
10306-2364
US

V. Phone/Fax

Practice location:
  • Phone: 718-987-5940
  • Fax: 718-667-9708
Mailing address:
  • Phone: 718-876-6220
  • Fax: 718-876-5969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF339405-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: