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General NPI Number Information
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NPI Number | 1114950425
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Entity Type | Individual
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Provider Name | MARLENE MINARIK PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 183RD STREET & 3RD AVENUE ST. BARNABAS HOSPITAL
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City | BRONX
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State | NY
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Zip | 10457
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Country | US
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Telephone | 718-960-6274
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Fax | 718-960-9404
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Provider Business Mailing Address
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Address Line | 3611 HENRY HUDSON PKWY APT 4B
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City | BRONX
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State | NY
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Zip | 10463-1553
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Country | US
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Telephone | 718-960-6274
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Fax | 718-960-9404
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 002184
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License Number State | NY
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