MEDICARE: DR. MARYSE I TESSIER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	045281	NY

General Provider Information

NPI Number	:	1134318413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARYSE I TESSIER

Provider Business Mailing Address
First Line	:	2801 GLENWOOD RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-2401
Country	:	US
Telephone Number	:	718-421-0224
Fax Number	:	718-859-1119

Provider Business Practice Location Address
First Line	:	2801 GLENWOOD RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-2401
Country	:	US
Telephone Number	:	718-421-0224
Fax Number	:	718-859-1119

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2007
Last Update Date	:	10/23/2007

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