Healthcare Provider Details

I. General information

NPI: 1760344600
Provider Name (Legal Business Name): MARYA KALIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 11/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2057 GATES AVE APT 2R
RIDGEWOOD NY
11385-3032
US

IV. Provider business mailing address

2057 GATES AVE APT 2R
RIDGEWOOD NY
11385-3032
US

V. Phone/Fax

Practice location:
  • Phone: 929-340-8543
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: