Provider Demographics
NPI:1396005088
Name:LAND, MARIE ELISE (MA)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:ELISE
Last Name:LAND
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 HARTWELL RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-1703
Mailing Address - Country:US
Mailing Address - Phone:914-310-0630
Mailing Address - Fax:
Practice Address - Street 1:107 HARTWELL RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-1703
Practice Address - Country:US
Practice Address - Phone:914-310-0630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist