Provider Demographics
NPI:1831711407
Name:JOAZILE, MARIE MARTHE (NP)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:MARTHE
Last Name:JOAZILE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24106 142ND AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-2008
Mailing Address - Country:US
Mailing Address - Phone:646-662-7935
Mailing Address - Fax:
Practice Address - Street 1:900 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROOSEVELT ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10044-0066
Practice Address - Country:US
Practice Address - Phone:212-848-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-17
Last Update Date:2020-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF309629-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health