Provider Demographics
NPI:1710418116
Name:HILAIRE, MARLIE
Entity type:Individual
Prefix:
First Name:MARLIE
Middle Name:
Last Name:HILAIRE
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 1:11944 218TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1911
Mailing Address - Country:US
Mailing Address - Phone:718-954-3553
Mailing Address - Fax:877-762-6647
Practice Address - Street 1:230 HILTON AVE STE 105
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-8116
Practice Address - Country:US
Practice Address - Phone:718-954-3553
Practice Address - Fax:877-762-6647
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340512363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily