Healthcare Provider Details

I. General information

NPI: 1811826340
Provider Name (Legal Business Name): MARLENE GURGIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 COURTNEY LOOP
STATEN ISLAND NY
10305-3152
US

IV. Provider business mailing address

65 COURTNEY LOOP
STATEN ISLAND NY
10305-3152
US

V. Phone/Fax

Practice location:
  • Phone: 917-201-0503
  • Fax:
Mailing address:
  • Phone: 917-201-0503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: