Healthcare Provider Details

I. General information

NPI: 1487197752
Provider Name (Legal Business Name): MARINA GEFEN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2016
Last Update Date: 11/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 HYLAN BLVD
STATEN ISLAND NY
10305-2020
US

IV. Provider business mailing address

154 CLARKE AVE
STATEN ISLAND NY
10306-1112
US

V. Phone/Fax

Practice location:
  • Phone: 347-729-4357
  • Fax:
Mailing address:
  • Phone: 347-729-4357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6202635
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: