Provider Demographics
NPI:1851462261
Name:CHEVRES, MARIANGELIQUE (ABO)
Entity Type:Individual
Prefix:MS
First Name:MARIANGELIQUE
Middle Name:
Last Name:CHEVRES
Suffix:
Gender:F
Credentials:ABO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3733 82ND ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7031
Mailing Address - Country:US
Mailing Address - Phone:718-458-8800
Mailing Address - Fax:718-458-9697
Practice Address - Street 1:3733 82ND ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7031
Practice Address - Country:US
Practice Address - Phone:718-458-8800
Practice Address - Fax:718-458-9697
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007177156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician