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NPI Code Detail

MEDICARE: DR. MARINA TAVER M.D.

MEDICARE: DR. MARINA TAVER 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
12084P0800XPsychiatry Physician208822NY

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 : 1780708511
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARINA TAVER M.D.
Provider Business Mailing Address
First Line : 3052 BRIGHTON 1ST ST
Second Line : APT 5D
City : BROOKLYN
State : NY
Zip : 11235-8088
Country : US
Telephone Number : 917-583-5454
Fax Number :
Provider Business Practice Location Address
First Line : 681 CLARKSON AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11203-2125
Country : US
Telephone Number : 718-221-7074
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2007
Last Update Date : 01/14/2016

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