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General NPI Number Information
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NPI Number | 1841748456
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Entity Type | Individual
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Provider Name | MARIANNA CORDOVANO PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/13/2016
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Last Update Date | 02/17/2017
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Provider Practice Location Address
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Address Line | 1090 AMSTERDAM AVE SUITE 10A
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City | NEW YORK
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State | NY
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Zip | 10025-1737
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Country | US
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Telephone | 212-523-5222
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Fax | 212-523-1761
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Provider Business Mailing Address
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Address Line | 1090 AMSTERDAM AVE SUITE 10A
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City | NEW YORK
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State | NY
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Zip | 10025-1737
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Country | US
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Telephone | 212-523-5222
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Fax | 212-523-1761
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 020501-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3667
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License Number State | CT
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