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NPI Code Detail

MEDICARE: MS. MARLENE BEATRICE TAYLOR PA

MEDICARE: MS. MARLENE BEATRICE TAYLOR PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant001834NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1001834OTHERNYLICENSE

General Provider Information

NPI Number : 1467678920
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARLENE BEATRICE TAYLOR PA
Provider Business Mailing Address
First Line : 3649 JOHNSON AVE # 3
Second Line :
City : BRONX
State : NY
Zip : 10463-1671
Country : US
Telephone Number : 718-601-4772
Fax Number :
Provider Business Practice Location Address
First Line : 1824 MADISON AVE FL 3
Second Line :
City : NEW YORK
State : NY
Zip : 10035-3832
Country : US
Telephone Number : 212-423-4532
Fax Number : 212-423-4045
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2007
Last Update Date : 07/08/2007

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Directions to “ MS. MARLENE BEATRICE TAYLOR PA” Practice Location

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