Provider Demographics
NPI:1932099454
Name:EMILSEN, MARLA EBONIQUE CIRITA (MS ED)
Entity type:Individual
Prefix:
First Name:MARLA EBONIQUE
Middle Name:CIRITA
Last Name:EMILSEN
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 E 82ND ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3305
Mailing Address - Country:US
Mailing Address - Phone:718-877-2100
Mailing Address - Fax:
Practice Address - Street 1:629 E 82ND ST FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3305
Practice Address - Country:US
Practice Address - Phone:718-877-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities