Provider Demographics
NPI:1831680677
Name:HAIRSTON, MARQUETTE
Entity Type:Individual
Prefix:
First Name:MARQUETTE
Middle Name:
Last Name:HAIRSTON
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:PO BOX 294
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-0294
Mailing Address - Country:US
Mailing Address - Phone:914-843-2456
Mailing Address - Fax:888-699-8221
Practice Address - Street 1:9 EDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-2503
Practice Address - Country:US
Practice Address - Phone:914-843-2456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator