Provider Demographics
NPI:1124456504
Name:BELOTTE, MARIE GINETTE
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:GINETTE
Last Name:BELOTTE
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 1:1430 ARNDT PL
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-1310
Mailing Address - Country:US
Mailing Address - Phone:321-412-0833
Mailing Address - Fax:
Practice Address - Street 1:1430 ARNDT PL
Practice Address - Street 2:
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-1310
Practice Address - Country:US
Practice Address - Phone:321-412-0833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY313362164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse