Provider Demographics
NPI:1679720692
Name:CASTAGNE-PETIT-FRERE, MARIE-ANGE JUDELINE (NP)
Entity type:Individual
Prefix:
First Name:MARIE-ANGE
Middle Name:JUDELINE
Last Name:CASTAGNE-PETIT-FRERE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:79-01 BROADWAY
Mailing Address - Street 2:DIVISION OF GASTROENTEROLOGY
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-7901
Mailing Address - Country:US
Mailing Address - Phone:718-334-3617
Mailing Address - Fax:718-334-1738
Practice Address - Street 1:79-01 BROADWAY
Practice Address - Street 2:DIVISION OF GASTROENTEROLOGY
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-7901
Practice Address - Country:US
Practice Address - Phone:718-334-3617
Practice Address - Fax:718-334-1738
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF335397363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily