Provider Demographics
NPI:1992273536
Name:MERISTYL EMMANUEL, MARIE PERRETTE
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:PERRETTE
Last Name:MERISTYL EMMANUEL
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 1:315 E 59TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-5440
Mailing Address - Country:US
Mailing Address - Phone:347-792-7931
Mailing Address - Fax:
Practice Address - Street 1:315 E 59TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-5440
Practice Address - Country:US
Practice Address - Phone:347-792-7931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-12
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF11240272363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care