1497719694 NPI number — DR. JOHN C MARZANO DPM

Table of content: DR. JOHN C MARZANO DPM (NPI 1497719694)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497719694 NPI number — DR. JOHN C MARZANO DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARZANO
Provider First Name:
JOHN
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARZANO
Provider Other First Name:
JOHN
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1497719694
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
984 N BROADWAY
Provider Second Line Business Mailing Address:
SUITE LL03
Provider Business Mailing Address City Name:
YONKERS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10701-1318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-423-0600
Provider Business Mailing Address Fax Number:
866-549-2795

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
984 N BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
YONKERS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10701-1318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-423-0600
Provider Business Practice Location Address Fax Number:
866-549-2795
Provider Enumeration Date:
04/14/2006

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: 213ES0131X , with the licence number:  N003773 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: N003773 , 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: 00851987 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 480018657 . This is a "INDIVIDUAL RR PROVIDER #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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