Provider Demographics
NPI:1750696746
Name:HARDWARE, MARJORIE MARIA
Entity type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:MARIA
Last Name:HARDWARE
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 1:72 HURTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2135
Mailing Address - Country:US
Mailing Address - Phone:631-265-3078
Mailing Address - Fax:631-265-2637
Practice Address - Street 1:72 HURTIN BLVD
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2135
Practice Address - Country:US
Practice Address - Phone:631-265-3078
Practice Address - Fax:631-265-2637
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221080-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse