Provider Demographics
NPI:1114439130
Name:TSIVIN, MARINA SHULAMIT (FNP)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:SHULAMIT
Last Name:TSIVIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 E 69TH ST APT 7F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5455
Mailing Address - Country:US
Mailing Address - Phone:347-342-7804
Mailing Address - Fax:
Practice Address - Street 1:1419 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4512
Practice Address - Country:US
Practice Address - Phone:718-907-4321
Practice Address - Fax:347-425-7681
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-31
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF342368-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty