Provider Demographics
NPI:1285884346
Name:BOSSOUS, MARJORIE
Entity type:Individual
Prefix:MISS
First Name:MARJORIE
Middle Name:
Last Name:BOSSOUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HELPFUL HAND AGENCY
Other - Middle Name:
Other - Last Name:AGENCY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:284753
Mailing Address - Street 1:14963 WELLER LN
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-2736
Mailing Address - Country:US
Mailing Address - Phone:718-421-4224
Mailing Address - Fax:
Practice Address - Street 1:14963 WELLER LN
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-2736
Practice Address - Country:US
Practice Address - Phone:718-421-4224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY284753164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02386450Medicaid