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General NPI Number Information
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NPI Number | 1740695717
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Entity Type | Organization
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Legal Business Name | MARINO D. TAVAREZ, MD, MPH PLLC
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Dates
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Enumeration Date | 06/27/2014
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Last Update Date | 01/05/2015
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Provider Practice Location Address
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Address Line | 150 JAY ST FINGER LAKES FAMILY MEDICINE
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City | GENEVA
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State | NY
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Zip | 14456-3212
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Country | US
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Telephone | 315-759-5426
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Fax | 585-486-1634
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Provider Business Mailing Address
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Address Line | 150 JAY ST FINGER LAKES FAMILY MEDICINE
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City | GENEVA
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State | NY
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Zip | 14456-3212
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Country | US
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Telephone | 315-759-5426
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Fax | 585-486-1634
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARINO DE JESUS TAVAREZ
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Credential | M.D.
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Telephone | 908-400-1843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 232852
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License Number State | NY
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