Provider Demographics
NPI:1063525046
Name:DESVARIEUX, MARIE-EDOUARD NATHALIE (MD, MS)
Entity type:Individual
Prefix:DR
First Name:MARIE-EDOUARD
Middle Name:NATHALIE
Last Name:DESVARIEUX
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 E DEER PARK RD
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4866
Mailing Address - Country:US
Mailing Address - Phone:917-517-1908
Mailing Address - Fax:
Practice Address - Street 1:3 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8303
Practice Address - Country:US
Practice Address - Phone:631-666-2290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222322207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI29303Medicare UPIN
NY632-251Medicare ID - Type Unspecified