Provider Demographics
NPI:1346997533
Name:FELIZIER, MARIE DOMINIQUE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:DOMINIQUE
Last Name:FELIZIER
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 1:1168 E 88TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4711
Mailing Address - Country:US
Mailing Address - Phone:516-788-1869
Mailing Address - Fax:
Practice Address - Street 1:271 NASSAU BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5313
Practice Address - Country:US
Practice Address - Phone:516-538-3220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024140225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist