Provider Demographics
NPI:1316282395
Name:CAJUSTE, MARIEKETLER (MS EDUCATION)
Entity type:Individual
Prefix:
First Name:MARIEKETLER
Middle Name:
Last Name:CAJUSTE
Suffix:
Gender:F
Credentials:MS EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W 25TH ST APT 13J
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6576
Mailing Address - Country:US
Mailing Address - Phone:917-478-5865
Mailing Address - Fax:
Practice Address - Street 1:292 MADISON AVENUE
Practice Address - Street 2:2ND FLOOR YAI LIFESTART
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017
Practice Address - Country:US
Practice Address - Phone:917-478-5865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1234698174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist