Provider Demographics
NPI:1225128937
Name:DECORSE, MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:
Last Name:DECORSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 PLEASANTVILLE RD. #4
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10510-1634
Mailing Address - Country:US
Mailing Address - Phone:914-762-5595
Mailing Address - Fax:914-206-3500
Practice Address - Street 1:1133 PLEASANTVILLE ROAD #4
Practice Address - Street 2:
Practice Address - City:BRIARCLIFF MANOR
Practice Address - State:NY
Practice Address - Zip Code:10510-1634
Practice Address - Country:US
Practice Address - Phone:914-762-5595
Practice Address - Fax:914-206-3500
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0908792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05A511OtherMEDICARE PROVIDER
NYA98096Medicare UPIN
NY05A511OtherMEDICARE PROVIDER
A98096Medicare UPIN