Provider Demographics
NPI:1134399660
Name:SEIDE-ANGLADE, MARIE
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:
Last Name:SEIDE-ANGLADE
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 1:1478 E 87TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5138
Mailing Address - Country:US
Mailing Address - Phone:718-360-7663
Mailing Address - Fax:
Practice Address - Street 1:1478 E 87TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-5138
Practice Address - Country:US
Practice Address - Phone:718-360-7663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities