Provider Demographics
NPI:1447338876
Name:MARSH, ELISSA (CNM)
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:
Last Name:MARSH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 TURNER PLAVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-3333
Mailing Address - Country:US
Mailing Address - Phone:917-620-4175
Mailing Address - Fax:
Practice Address - Street 1:15 TURNER PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-3311
Practice Address - Country:US
Practice Address - Phone:917-620-4175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000157176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife