Provider Demographics
NPI:1457502783
Name:DESIMPLICIIS, MARIA I
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:I
Last Name:DESIMPLICIIS
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 1:8214 LANGDALE ST FL 1
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1821
Mailing Address - Country:US
Mailing Address - Phone:718-347-0202
Mailing Address - Fax:
Practice Address - Street 1:8214 LANGDALE ST FL 1
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1821
Practice Address - Country:US
Practice Address - Phone:718-347-0202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053766320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities