Provider Demographics
NPI:1407331200
Name:BORDEOS, MARIE JOY GUNDRAN (NP)
Entity Type:Individual
Prefix:
First Name:MARIE JOY
Middle Name:GUNDRAN
Last Name:BORDEOS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8610 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7503
Mailing Address - Country:US
Mailing Address - Phone:718-565-6880
Mailing Address - Fax:
Practice Address - Street 1:8610 ROOSEVELT AVE STE 2
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7500
Practice Address - Country:US
Practice Address - Phone:718-565-6880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2019-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF343535363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily