MEDICARE: MARLENE MARIA NIEVES PA-C

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
1	363A00000X	Physician Assistant	034712-01	NY

General Provider Information

NPI Number	:	1942077037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLENE MARIA NIEVES PA-C

Provider Business Mailing Address
First Line	:	7901 BROADWAY
Second Line	:
City	:	ELMHURST
State	:	NY
Zip	:	11373-1329
Country	:	US
Telephone Number	:	718-334-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	7901 BROADWAY
Second Line	:
City	:	ELMHURST
State	:	NY
Zip	:	11373-1329
Country	:	US
Telephone Number	:	718-334-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2023
Last Update Date	:	12/29/2025

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Directions to “ MARLENE MARIA NIEVES PA-C” Practice Location

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