Provider Demographics
NPI:1346432945
Name:SEO, MARIA T (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:T
Last Name:SEO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:22 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-1912
Mailing Address - Country:US
Mailing Address - Phone:551-587-3252
Mailing Address - Fax:201-221-8427
Practice Address - Street 1:445 PARK AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-2735
Practice Address - Country:US
Practice Address - Phone:718-963-0800
Practice Address - Fax:718-534-5221
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00143700363LA2200X
NY304723363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05294853Medicaid