Provider Demographics
NPI:1285920439
Name:JOSEPH, MARIE C (LPN)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:C
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 BOWLING LN
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-6724
Mailing Address - Country:US
Mailing Address - Phone:646-641-4066
Mailing Address - Fax:
Practice Address - Street 1:105 BOWLING LN
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-6724
Practice Address - Country:US
Practice Address - Phone:646-641-4066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300771164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse