Healthcare Provider Details

I. General information

NPI: 1649367715
Provider Name (Legal Business Name): RALPH MARIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date: 07/17/2007
Reactivation Date: 04/20/2010

III. Provider practice location address

4600 LIVINGSTON AVE
BRONX NY
10471-3335
US

IV. Provider business mailing address

PO BOX 29751
NEW YORK NY
10087-9751
US

V. Phone/Fax

Practice location:
  • Phone: 212-590-5710
  • Fax: 212-590-5750
Mailing address:
  • Phone: 212-746-0373
  • Fax: 212-746-7481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number177900
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: