Healthcare Provider Details

I. General information

NPI: 1093631707
Provider Name (Legal Business Name): YAMIRY MARRERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

776 E 3RD AVE
ROSELLE NJ
07203-1698
US

IV. Provider business mailing address

450 VERONA AVE
ELIZABETH NJ
07208-1430
US

V. Phone/Fax

Practice location:
  • Phone: 908-241-5545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number26NJ15586100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: