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General NPI Number Information
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NPI Number | 1902132384
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Entity Type | Individual
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Provider Name | JACKLEEN SULEIMAN MARJI MD, PHD
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Gender | Female
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Dates
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Enumeration Date | 10/20/2009
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Last Update Date | 04/05/2021
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Provider Practice Location Address
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Address Line | 161 FORT WASHINGTON AVE HERBERT IRVING PAVILION, RM 1264
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City | NEW YORK
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State | NY
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Zip | 10032-3729
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Country | US
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Telephone | 212-305-6953
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Fax | 212-305-0286
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Provider Business Mailing Address
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Address Line | 161 FORT WASHINGTON AVE HERBERT IRVING PAVILION, RM 1264
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City | NEW YORK
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State | NY
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Zip | 10032-3729
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Country | US
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Telephone | 212-305-6953
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Fax | 212-305-0286
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 246029
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License Number State | NY
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