Healthcare Provider Details

I. General information

NPI: 1396842852
Provider Name (Legal Business Name): MARINA CATALLOZZI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY COLUMBIA UNIVERSITY DEPARTMT PEDIATRICS
NEW YORK NY
10032
US

IV. Provider business mailing address

3959 BROADWAY COLUMBIA UNIVERSITY DEPARTMT PEDIATRICS
NEW YORK NY
10032
US

V. Phone/Fax

Practice location:
  • Phone: 212-304-7250
  • Fax: 212-544-1974
Mailing address:
  • Phone: 212-304-7250
  • Fax: 212-544-1974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number232352
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number232352
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: