1073623989 NPI number — MRS. UGYNNIE GUILLERMO MARQUEZ ROSARION PT

Table of content: MRS. UGYNNIE GUILLERMO MARQUEZ ROSARION PT (NPI 1073623989)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073623989 NPI number — MRS. UGYNNIE GUILLERMO MARQUEZ ROSARION PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARQUEZ ROSARION
Provider First Name:
UGYNNIE
Provider Middle Name:
GUILLERMO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARQUEZ
Provider Other First Name:
UGYNNIE
Provider Other Middle Name:
GUILLERMO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1073623989
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40-24 76TH STREET
Provider Second Line Business Mailing Address:
SUITE 1B
Provider Business Mailing Address City Name:
ELMHURST
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11373-1004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-205-9020
Provider Business Mailing Address Fax Number:
718-205-7030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40-24 76TH STREET
Provider Second Line Business Practice Location Address:
SUITE 1B
Provider Business Practice Location Address City Name:
ELMHURST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11373-1004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-205-9020
Provider Business Practice Location Address Fax Number:
718-205-7030
Provider Enumeration Date:
08/30/2006

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: 225100000X , with the licence number:  40AZ01148800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 025651-1 , 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)





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