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NPI Code Detail

MEDICARE: MARINA BOUKIIA M.D.

MEDICARE: MARINA BOUKIIA M.D.
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
1174400000XSpecialistMA 67562NJ
2207L00000XAnesthesiology Physician25MA06756200NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588667711
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARINA BOUKIIA M.D.
Provider Business Mailing Address
First Line : PO BOX 343
Second Line :
City : MIDLAND PARK
State : NJ
Zip : 07432-0343
Country : US
Telephone Number : 201-804-2800
Fax Number :
Provider Business Practice Location Address
First Line : 525 UNION BLVD
Second Line :
City : TOTOWA
State : NJ
Zip : 07512-2442
Country : US
Telephone Number : 973-928-5360
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 08/08/2023

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Directions to “ MARINA BOUKIIA M.D.” Practice Location

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