Healthcare Provider Details

I. General information

NPI: 1194721043
Provider Name (Legal Business Name): MARIAN DAVID, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 06/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12510 QUEENS BLVD SUITE 2701
KEW GARDENS NY
11415-1519
US

IV. Provider business mailing address

12510 QUEENS BLVD SUITE 2701
KEW GARDENS NY
11415-1519
US

V. Phone/Fax

Practice location:
  • Phone: 718-261-0444
  • Fax: 718-261-0940
Mailing address:
  • Phone: 718-261-0444
  • Fax: 718-261-0940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number211683
License Number StateNY

VIII. Authorized Official

Name: MARIAN DAVID
Title or Position: OWNER
Credential: MD
Phone: 718-261-0444