Provider Demographics
NPI:1396404505
Name:MODESTE, MARCLYN
Entity Type:Individual
Prefix:
First Name:MARCLYN
Middle Name:
Last Name:MODESTE
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 1:10450 102ND ST APT 2E
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-2204
Mailing Address - Country:US
Mailing Address - Phone:929-354-1829
Mailing Address - Fax:
Practice Address - Street 1:10450 102ND ST APT 2E
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-2204
Practice Address - Country:US
Practice Address - Phone:929-354-1829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other