Provider Demographics
NPI:1770309478
Name:NANQUIL, MARIE ANTONETTE
Entity type:Individual
Prefix:
First Name:MARIE ANTONETTE
Middle Name:
Last Name:NANQUIL
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 1:8746 20TH AVE # L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4802
Mailing Address - Country:US
Mailing Address - Phone:718-648-0888
Mailing Address - Fax:
Practice Address - Street 1:798 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-2115
Practice Address - Country:US
Practice Address - Phone:718-648-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053689225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist