Individual
MARIA ELLISE NATIVIDAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
79 MIDDLEVILLE RD, NORTHPORT, NY 11768-2200
(631) 261-4400
Mailing address
PO BOX 201, NORTHPORT, NY 11768-0201
(254) 495-9891
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
390200000X
NY
Other
Enumeration date
06/27/2011
Last updated
06/27/2011
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