Healthcare Provider Details

I. General information

NPI: 1770546939
Provider Name (Legal Business Name): MARJORIE JEAN-MICHEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GRAND CONCOURSE DEPARTMENT OF OB/GYN, 5TH FLOOR
BRONX NY
10457-7606
US

IV. Provider business mailing address

1650 GRAND CONCOURSE DEPARTMENT OF OB/GYN, 5TH FLOOR
BRONX NY
10457-7606
US

V. Phone/Fax

Practice location:
  • Phone: 718-239-8389
  • Fax: 718-239-8360
Mailing address:
  • Phone: 718-239-8389
  • Fax: 718-239-8360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME0094120
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number250376
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: