Provider Demographics
NPI:1659615474
Name:SEIDE, MARIE THERESE (RN)
Entity Type:Individual
Prefix:MISS
First Name:MARIE
Middle Name:THERESE
Last Name:SEIDE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:THERESE
Other - Last Name:SEIDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:558 CHRISTOPHER AVE
Mailing Address - Street 2:BROOKLYN
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-7030
Mailing Address - Country:US
Mailing Address - Phone:347-693-8012
Mailing Address - Fax:
Practice Address - Street 1:1663 EAST 17ST,
Practice Address - Street 2:COMPREHENSIVE NETWORK INC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229
Practice Address - Country:US
Practice Address - Phone:718-339-9700
Practice Address - Fax:718-645-3837
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY474511163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3476938012Medicare NSC