Healthcare Provider Details

I. General information

NPI: 1477532828
Provider Name (Legal Business Name): LUAY S MARJI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LUAY S. MARJI MD

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 01/08/2024
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 PARK AVE
YONKERS NY
10703-2937
US

IV. Provider business mailing address

9 HIDDEN GLEN RD
SCARSDALE NY
10583-1230
US

V. Phone/Fax

Practice location:
  • Phone: 914-375-4433
  • Fax: 914-375-1771
Mailing address:
  • Phone: 914-375-4433
  • Fax: 914-375-1771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number204489
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number204489
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number204489
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number204489
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: