Provider Demographics
NPI:1689233769
Name:GIUSTINO, MARIE ALEXIS (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:ALEXIS
Last Name:GIUSTINO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 N BROADWAY STE 400
Mailing Address - Street 2:
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:10591-1076
Mailing Address - Country:US
Mailing Address - Phone:914-366-3400
Mailing Address - Fax:914-366-3407
Practice Address - Street 1:755 N BROADWAY STE 400
Practice Address - Street 2:
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-1076
Practice Address - Country:US
Practice Address - Phone:914-366-3400
Practice Address - Fax:914-366-3407
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF382973208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty