Healthcare Provider Details

I. General information

NPI: 1639460041
Provider Name (Legal Business Name): BELINDA A MARQUIS,MD,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1543 STRAIGHT PATH
WYANDANCH NY
11798-3415
US

IV. Provider business mailing address

1543 STRAIGHT PATH
WYANDANCH NY
11798-3415
US

V. Phone/Fax

Practice location:
  • Phone: 631-643-6006
  • Fax: 631-643-7026
Mailing address:
  • Phone: 631-643-6006
  • Fax: 631-920-6047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number166813
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. BELINDA AGHARESE MARQUIS
Title or Position: PRESIDENT
Credential: MD
Phone: 631-643-6006