Provider Demographics
NPI:1144751389
Name:CERISIER, MARIAN PRINCESS SORIANO
Entity Type:Individual
Prefix:
First Name:MARIAN PRINCESS
Middle Name:SORIANO
Last Name:CERISIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIAN PRINCESS
Other - Middle Name:PALACIO
Other - Last Name:SORIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:225 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-1923
Mailing Address - Country:US
Mailing Address - Phone:347-394-9046
Mailing Address - Fax:
Practice Address - Street 1:225 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-1923
Practice Address - Country:US
Practice Address - Phone:347-394-9046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036069225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist