Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 205926-1 | NY |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 205926-1 | NY |
N | 207NS0135X | Procedural Dermatology | 205926-1 | NY |
NPI | 1205835790 |
---|---|
Provider Name | Dr. Gina Maria Marrero |
First Address | Lynbrook, NY 11563-2400 |
Second Address | Lynbrook, NY 11563-2400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2005 |
Last Update Date | 10/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01886828 | (05) | NY |
G67047 | (02) | NY |