Healthcare Provider Details

I. General information

NPI: 1699742551
Provider Name (Legal Business Name): ANTHONY I MARQUINEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 01/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 ESSEX STREET SUITE 202
HACKENSACK NJ
07601
US

IV. Provider business mailing address

211 ESSEX STREET SUITE 202
HACKENSACK NJ
07601
US

V. Phone/Fax

Practice location:
  • Phone: 201-488-1515
  • Fax: 201-488-9471
Mailing address:
  • Phone: 201-488-1515
  • Fax: 201-488-9471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA067502
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA06750200
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: