Provider Demographics
NPI:1689711376
Name:MAURICE, GERALDINE (MS)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:
Last Name:MAURICE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-1725
Mailing Address - Country:US
Mailing Address - Phone:631-789-8558
Mailing Address - Fax:
Practice Address - Street 1:16 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-1725
Practice Address - Country:US
Practice Address - Phone:631-789-8558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist