Provider Demographics
NPI:1336470749
Name:ALARCON, MARIE ELIZABETH (ANP)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:ELIZABETH
Last Name:ALARCON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BEDFORD AVE
Mailing Address - Street 2:PORT JEFFERSON STATION
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-4001
Mailing Address - Country:US
Mailing Address - Phone:516-356-3486
Mailing Address - Fax:
Practice Address - Street 1:NICOLLS RD HSC LEVEL 12 RM 080
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-7130
Practice Address - Country:US
Practice Address - Phone:631-444-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30-305171363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health