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NPI Code Detail

MEDICARE: MARLYN CABANA GONONG RN

MEDICARE: MARLYN CABANA GONONG RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse591508NY

General Provider Information

NPI Number : 1144955188
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARLYN CABANA GONONG RN
Provider Business Mailing Address
First Line : 3805 CRESCENT ST APT 1F
Second Line :
City : LONG ISLAND CITY
State : NY
Zip : 11101-3621
Country : US
Telephone Number : 347-260-8547
Fax Number :
Provider Business Practice Location Address
First Line : 3805 CRESCENT ST APT 1F
Second Line :
City : LONG ISLAND CITY
State : NY
Zip : 11101-3621
Country : US
Telephone Number : 347-260-8547
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2022
Last Update Date : 07/22/2022

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