1477059509 NPI number — DR. URIELLE MARSEILLE MD

Table of content: DR. URIELLE MARSEILLE MD (NPI 1477059509)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477059509 NPI number — DR. URIELLE MARSEILLE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARSEILLE
Provider First Name:
URIELLE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1477059509
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
99 HAWLEY LN FL 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STRATFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06614-1202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-502-4650
Provider Business Mailing Address Fax Number:
475-246-9894

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
196 PARKWAY S
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
WATERFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-437-6764
Provider Business Practice Location Address Fax Number:
860-865-2392
Provider Enumeration Date:
04/05/2018

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: 207Q00000X , with the licence number:  68065 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 68065 . This is a "LICENSE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1477059509 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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