1346497427 NPI number — MRS. MARIE JOSE NAZAIRE LPN

Table of content: MRS. MARIE JOSE NAZAIRE LPN (NPI 1346497427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346497427 NPI number — MRS. MARIE JOSE NAZAIRE LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAZAIRE
Provider First Name:
MARIE
Provider Middle Name:
JOSE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346497427
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
327 TERRACE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAYPORT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11705-1525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 OLD COUNTRY RD
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
WESTBURY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11590-5156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-794-0700
Provider Business Practice Location Address Fax Number:
516-794-0787
Provider Enumeration Date:
08/20/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  2721091 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)