Provider Demographics
NPI:1710519327
Name:ZEPHIRIN, MARIE JUDITH (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:JUDITH
Last Name:ZEPHIRIN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 NIMROD CT
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-1502
Mailing Address - Country:US
Mailing Address - Phone:631-455-4465
Mailing Address - Fax:
Practice Address - Street 1:612 NIMROD CT
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-1502
Practice Address - Country:US
Practice Address - Phone:631-455-4465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY592422163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice