Healthcare Provider Details

I. General information

NPI: 1578488136
Provider Name (Legal Business Name): MARC HERALDE MARDY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CYRUS AVE
BROOKLYN NY
11229-6067
US

IV. Provider business mailing address

20 CYRUS AVE
BROOKLYN NY
11229-6067
US

V. Phone/Fax

Practice location:
  • Phone: 718-493-3824
  • Fax:
Mailing address:
  • Phone: 347-406-3464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number998955001
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: