Provider Demographics
NPI:1558309146
Name:FRANCILLON, MARIE L (MD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:L
Last Name:FRANCILLON
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 1:1000 ZECKENDORF BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2133
Mailing Address - Country:US
Mailing Address - Phone:516-542-6880
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:16959 137TH AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-4517
Practice Address - Country:US
Practice Address - Phone:718-525-5600
Practice Address - Fax:718-559-5285
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180362207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01170089Medicaid
NY37F861Medicare ID - Type Unspecified
NY01170089Medicaid
NY9255SNMedicare PIN