Provider Demographics
NPI:1467724948
Name:MARSEILLE, JOSEPH A (FPMHNP)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:A
Last Name:MARSEILLE
Suffix:
Gender:M
Credentials:FPMHNP
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:A
Other - Last Name:MARSEILLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:21 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTN STA
Mailing Address - State:NY
Mailing Address - Zip Code:11746-2104
Mailing Address - Country:US
Mailing Address - Phone:631-547-1830
Mailing Address - Fax:631-547-1830
Practice Address - Street 1:355 W 15TH ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-6305
Practice Address - Country:US
Practice Address - Phone:631-988-2983
Practice Address - Fax:631-761-3129
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY634215163W00000X
NYF405958-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse