Provider Demographics
NPI:1801996335
Name:DAVID, MARJORY CLIDE (FNP)
Entity type:Individual
Prefix:MRS
First Name:MARJORY
Middle Name:CLIDE
Last Name:DAVID
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARJORY
Other - Middle Name:CLIDE
Other - Last Name:JEAN-ANTOINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:276 BABYLON TPKE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-1818
Mailing Address - Country:US
Mailing Address - Phone:516-647-1678
Mailing Address - Fax:516-546-0828
Practice Address - Street 1:242 MERRICK RD
Practice Address - Street 2:SUITE 304
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5254
Practice Address - Country:US
Practice Address - Phone:516-764-7070
Practice Address - Fax:516-764-7073
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331773363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily