Healthcare Provider Details

I. General information

NPI: 1356615330
Provider Name (Legal Business Name): MARCIA JAN MAHARAM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. MARCIA JAN MICHELSON

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 03/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 W 78TH ST ATTN: PS 87 SCHOOL NURSE
NEW YORK NY
10024-6701
US

IV. Provider business mailing address

160 W 78TH ST ATTN: PS 87 SCHOOL NURSE
NEW YORK NY
10024-6701
US

V. Phone/Fax

Practice location:
  • Phone: 212-678-2826
  • Fax: 212-678-5886
Mailing address:
  • Phone: 212-678-2826
  • Fax: 212-678-5886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number374555-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: