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General NPI Number Information
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NPI Number | 1740778208
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Entity Type | Individual
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Provider Name | MARK MARAJ PA-C
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Gender | Male
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Dates
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Enumeration Date | 04/30/2018
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 7901 BROADWAY
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City | ELMHURST
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State | NY
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Zip | 11373-1329
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Country | US
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Telephone | 718-334-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 10601 109TH AVE
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City | OZONE PARK
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State | NY
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Zip | 11417-2326
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Country | US
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Telephone | 718-323-1180
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Fax |
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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 | 021994
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License Number State | NY
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