Provider Demographics
NPI:1659684132
Name:THELUSCA, MARIE CLAUDE
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:CLAUDE
Last Name:THELUSCA
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 1:1228 E 86TH ST
Mailing Address - Street 2:1228 EAST 86STREET
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4928
Mailing Address - Country:US
Mailing Address - Phone:718-444-1669
Mailing Address - Fax:
Practice Address - Street 1:16937 144TH RD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-5929
Practice Address - Country:US
Practice Address - Phone:718-978-7221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301273-1164W00000X
NY301273167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No167G00000XNursing Service ProvidersLicensed Psychiatric Technician