Healthcare Provider Details

I. General information

NPI: 1215101910
Provider Name (Legal Business Name): MARIAN IWAMOTO MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 E LINCOLN AVE RY34-A500
RAHWAY NJ
07065-0900
US

IV. Provider business mailing address

126 E LINCOLN AVE RY34-A500
RAHWAY NJ
07065-0900
US

V. Phone/Fax

Practice location:
  • Phone: 732-594-4947
  • Fax: 908-823-3620
Mailing address:
  • Phone: 732-594-4947
  • Fax: 908-823-3620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA07432200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number25MA07432200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: