Provider Demographics
NPI:1285020842
Name:FEST, MARINA (NP)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:FEST
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 NEW DORP LN STE A
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2364
Mailing Address - Country:US
Mailing Address - Phone:718-876-6220
Mailing Address - Fax:718-876-5969
Practice Address - Street 1:470 SEAVIEW AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3401
Practice Address - Country:US
Practice Address - Phone:718-987-5940
Practice Address - Fax:718-667-9708
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF339405-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400194285OtherMEDICARE
NY04251263Medicaid