Provider Demographics
NPI:1639350788
Name:ATSISEY, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:ATSISEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 LAFAYETTE AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-2843
Mailing Address - Country:US
Mailing Address - Phone:347-650-4141
Mailing Address - Fax:
Practice Address - Street 1:1860 LAFAYETTE AVE APT 1B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-2843
Practice Address - Country:US
Practice Address - Phone:347-658-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY599518-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse