Provider Demographics
NPI:1093522823
Name:ESTERLIN, MARIE ILZA (AGNP)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:ILZA
Last Name:ESTERLIN
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-1802
Mailing Address - Country:US
Mailing Address - Phone:862-902-3469
Mailing Address - Fax:
Practice Address - Street 1:23 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-1802
Practice Address - Country:US
Practice Address - Phone:862-902-3469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15234800207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine