Healthcare Provider Details

I. General information

NPI: 1386224400
Provider Name (Legal Business Name): MARALIN LOWE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17520 HILLSIDE AVE
JAMAICA NY
11432-5773
US

IV. Provider business mailing address

13524 229TH ST
LAURELTON NY
11413-2524
US

V. Phone/Fax

Practice location:
  • Phone: 718-558-7230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number360118
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: