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General NPI Number Information
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NPI Number | 1770696650
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Entity Type | Organization
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Legal Business Name | MARIANNE MEDICAL SERVICE P.C
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 06/19/2018
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Provider Practice Location Address
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Address Line | 19 SCHERMERHORN ST
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City | BROOKLYN
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State | NY
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Zip | 11201
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Country | US
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Telephone | 718-448-6034
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Fax | 718-448-5396
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Provider Business Mailing Address
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Address Line | 665 CLOVE RD
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City | STATEN ISLAND
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State | NY
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Zip | 10310-2737
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Country | US
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Telephone | 718-448-6034
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Fax | 718-448-5396
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Authorized Official
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Title or Position | PRINCIPAL OFFICER
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Name | DR. KAMALINI ASIRWATHAM
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Credential | M.D.
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Telephone | 718-448-6034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 231851
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License Number State | NY
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