Individual
MARVIN LOUIE CUSTODIO ENERIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1468 MADISON AVE, NEW YORK, NY 10029-6508
(347) 862-8973
Mailing address
362 W 116TH ST APT 2B, NEW YORK, NY 10026-2068
(347) 862-8973
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
403815
NY
Other
Enumeration date
10/25/2021
Last updated
02/01/2022
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