Provider Demographics
NPI:1891040192
Name:ALBERIC, MARIE MELIANCE
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:MELIANCE
Last Name:ALBERIC
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 1:692 E 43RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-6507
Mailing Address - Country:US
Mailing Address - Phone:718-856-3041
Mailing Address - Fax:
Practice Address - Street 1:692 E 43RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-6507
Practice Address - Country:US
Practice Address - Phone:718-856-3041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY814336174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY174400000X-SPECIALISOtherSERVICE PROVIDER