Provider Demographics
NPI:1437385275
Name:DEVEZIN, MARIE J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:J
Last Name:DEVEZIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 ELM DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-3012
Mailing Address - Country:US
Mailing Address - Phone:516-621-6579
Mailing Address - Fax:
Practice Address - Street 1:405 ELM DR
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-3012
Practice Address - Country:US
Practice Address - Phone:516-621-6579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213440208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice