Provider Demographics
NPI:1619271053
Name:TIME, MARIE RODOLPHE (RPA-C)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:RODOLPHE
Last Name:TIME
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 SAINT PAULS PL
Mailing Address - Street 2:APT 2H
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-1673
Mailing Address - Country:US
Mailing Address - Phone:718-826-8860
Mailing Address - Fax:
Practice Address - Street 1:3201 KINGS HIGHWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11239
Practice Address - Country:US
Practice Address - Phone:718-252-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014534363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant