Healthcare Provider Details

I. General information

NPI: 1558562439
Provider Name (Legal Business Name): MARIE QUETLY CAZEAU ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 GREENFIELD RD
SYOSSET NY
11791-4831
US

IV. Provider business mailing address

11 MANOR PL
HUNTINGTON STATION NY
11746-1545
US

V. Phone/Fax

Practice location:
  • Phone: 516-496-7900
  • Fax: 516-496-2139
Mailing address:
  • Phone: 516-242-1926
  • Fax: 516-496-2139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF303671
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: