Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 023465 | NY |
NPI | 1598746315 |
---|---|
Provider Name | Dr. Alvaro Jose Marin |
First Address | Jackson Heights, NY 11372-7017 |
Second Address | Jackson Heights, NY 11372-7017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 08/07/2007 |