1902132384 NPI number — DR. JACKLEEN SULEIMAN MARJI MD, PHD

Table of content: DR. JACKLEEN SULEIMAN MARJI MD, PHD (NPI 1902132384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902132384 NPI number — DR. JACKLEEN SULEIMAN MARJI MD, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARJI
Provider First Name:
JACKLEEN
Provider Middle Name:
SULEIMAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, PHD
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:
1902132384
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
161 FORT WASHINGTON AVE
Provider Second Line Business Mailing Address:
HERBERT IRVING PAVILION, RM 1264
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10032-3729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-305-6953
Provider Business Mailing Address Fax Number:
212-305-0286

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
161 FORT WASHINGTON AVE
Provider Second Line Business Practice Location Address:
HERBERT IRVING PAVILION, RM 1264
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10032-3729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-305-6953
Provider Business Practice Location Address Fax Number:
212-305-0286
Provider Enumeration Date:
10/20/2009

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: 207N00000X , with the licence number:  246029 , 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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