Healthcare Provider Details

I. General information

NPI: 1225017536
Provider Name (Legal Business Name): ENG MEE MOONG MARILYN PAN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 MARKET ST 2M
NEW YORK NY
10002-8400
US

IV. Provider business mailing address

48 MARKET ST 2M
NEW YORK NY
10002-8400
US

V. Phone/Fax

Practice location:
  • Phone: 212-766-9751
  • Fax: 212-766-1158
Mailing address:
  • Phone: 212-766-9751
  • Fax: 212-766-1158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberF000340
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: