MEDICARE: MRS. ARELYS MARMOLEJOS MA

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
1	174400000X	Specialist		NY

General Provider Information

NPI Number	:	1851635932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ARELYS MARMOLEJOS MA

Provider Business Mailing Address
First Line	:	47 OAK ST APT 4
Second Line	:
City	:	MOUNT VERNON
State	:	NY
Zip	:	10550-1834
Country	:	US
Telephone Number	:	914-356-1189
Fax Number	:

Provider Business Practice Location Address
First Line	:	47 OAK ST APT 4
Second Line	:
City	:	MOUNT VERNON
State	:	NY
Zip	:	10550-1834
Country	:	US
Telephone Number	:	914-356-1189
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	11/15/2012

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