Healthcare Provider Details

I. General information

NPI: 1467010389
Provider Name (Legal Business Name): DR. EMMANUEL MARRERO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6339 ALGON AVE
PHILADELPHIA PA
19111-5802
US

IV. Provider business mailing address

6339 ALGON AVE
PHILADELPHIA PA
19111-5802
US

V. Phone/Fax

Practice location:
  • Phone: 267-388-7434
  • Fax:
Mailing address:
  • Phone: 267-815-8544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number38643601
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number38643601
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: