Provider Demographics
NPI:1104707769
Name:ALTAVILLA, MARIE SETON (MASTER OF SCIENCE)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:SETON
Last Name:ALTAVILLA
Suffix:
Gender:F
Credentials:MASTER OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37A BELL DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-1607
Mailing Address - Country:US
Mailing Address - Phone:845-705-4790
Mailing Address - Fax:
Practice Address - Street 1:37A BELL DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-1607
Practice Address - Country:US
Practice Address - Phone:845-705-4790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty