Provider Demographics
NPI:1316192552
Name:CELESTIN, MARIE FLORENCE (MD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:FLORENCE
Last Name:CELESTIN
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 1:6 MILLBROOK CT
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-7900
Mailing Address - Country:US
Mailing Address - Phone:631-486-9402
Mailing Address - Fax:
Practice Address - Street 1:1550 DEER PARK AVE STE 2
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-6624
Practice Address - Country:US
Practice Address - Phone:631-486-9402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY260716207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program