Healthcare Provider Details

I. General information

NPI: 1760247860
Provider Name (Legal Business Name): MARIE OCCEAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2024
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 EMERSON PL
VALLEY STREAM NY
11580-2806
US

IV. Provider business mailing address

374 EMERSON PL
VALLEY STREAM NY
11580-2806
US

V. Phone/Fax

Practice location:
  • Phone: 917-547-2716
  • Fax:
Mailing address:
  • Phone: 917-547-2716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF310994-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number638159-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: