Healthcare Provider Details

I. General information

NPI: 1588940175
Provider Name (Legal Business Name): MARILYN F ROBINSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 CHICAGO AVE
STATEN ISLAND NY
10305-3757
US

IV. Provider business mailing address

36 METCALFE ST
STATEN ISLAND NY
10304-1878
US

V. Phone/Fax

Practice location:
  • Phone: 718-442-7828
  • Fax: 718-556-2516
Mailing address:
  • Phone: 347-524-9426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number392228
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: