1255367678 NPI number — WANDA TEODOROWICZ-MARINO MD

Table of content: WANDA TEODOROWICZ-MARINO MD (NPI 1255367678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255367678 NPI number — WANDA TEODOROWICZ-MARINO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TEODOROWICZ-MARINO
Provider First Name:
WANDA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255367678
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2242 CENTRAL PARK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YONKERS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10710-1457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-793-7111
Provider Business Mailing Address Fax Number:
914-793-1325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2242 CENTRAL PARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YONKERS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10710-1457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-793-7111
Provider Business Practice Location Address Fax Number:
914-793-1325
Provider Enumeration Date:
06/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  143436 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 143436 . This is a "MEDICAL LICENCE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P1218912 . This is a "OXFORD ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00851501 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0888912 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 143436A-40 . This is a "1199" identifier . This identifiers is of the category "OTHER".
  • Identifier: 143436A-40 . This is a "HEALTH FIRST 65" identifier . This identifiers is of the category "OTHER".
  • Identifier: 18002947 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4412490 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0091319 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 133295758 . This is a "TAX ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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