Provider Demographics
NPI:1043215320
Name:MARINBAKH, ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:MARINBAKH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 QUENTIN RD
Mailing Address - Street 2:APT A22
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2379
Mailing Address - Country:US
Mailing Address - Phone:718-646-0909
Mailing Address - Fax:718-646-8688
Practice Address - Street 1:2844 OCEAN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7900
Practice Address - Country:US
Practice Address - Phone:718-646-0909
Practice Address - Fax:718-646-8688
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211186208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02138801Medicaid
NYOS2981Medicare ID - Type Unspecified
NY02138801Medicaid