Healthcare Provider Details

I. General information

NPI: 1740811124
Provider Name (Legal Business Name): RAY MARRERO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1369 BROADWAY FL 2
NEW YORK NY
10018-7215
US

IV. Provider business mailing address

1369 BROADWAY FL 2
NEW YORK NY
10018-7215
US

V. Phone/Fax

Practice location:
  • Phone: 212-268-8830
  • Fax:
Mailing address:
  • Phone: 212-268-8830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: