Provider Demographics
NPI:1417113655
Name:MOISE, MARIE M (LPN)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:M
Last Name:MOISE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 FLATBUSH AVE
Mailing Address - Street 2:#2N
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-4966
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:590 FLATBUSH AVE
Practice Address - Street 2:#2N
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-4966
Practice Address - Country:US
Practice Address - Phone:212-867-6530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175159-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse