Provider Demographics
NPI:1174765168
Name:NAZAIRE, MARIE B (RPA)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:B
Last Name:NAZAIRE
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Gender:F
Credentials:RPA
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Mailing Address - Street 1:135 OLD EAST NECK RD
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3219
Mailing Address - Country:US
Mailing Address - Phone:631-293-0065
Mailing Address - Fax:718-563-4039
Practice Address - Street 1:198 FOSTER AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2134
Practice Address - Country:US
Practice Address - Phone:718-854-3005
Practice Address - Fax:718-854-9803
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2016-02-26
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Provider Licenses
StateLicense IDTaxonomies
NY004035363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant