Provider Demographics
NPI:1336314285
Name:LEDWIDGE, MARCIA AMOY
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:AMOY
Last Name:LEDWIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 ASH ST
Mailing Address - Street 2:BOX 144
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-3828
Mailing Address - Country:US
Mailing Address - Phone:631-232-3558
Mailing Address - Fax:
Practice Address - Street 1:46 ASH ST
Practice Address - Street 2:BOX 144
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-3828
Practice Address - Country:US
Practice Address - Phone:631-232-3558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY599750 -1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse