Provider Demographics
NPI:1093058828
Name:KHRIZMAN, MARINA (DO)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:KHRIZMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARINA
Other - Middle Name:
Other - Last Name:KORKMAZSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:19 DAVIS AVE
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4488
Mailing Address - Country:US
Mailing Address - Phone:614-722-4411
Mailing Address - Fax:614-722-6132
Practice Address - Street 1:700 CHILDRENS DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2664
Practice Address - Country:US
Practice Address - Phone:614-722-4411
Practice Address - Fax:614-722-6132
Is Sole Proprietor?:No
Enumeration Date:2013-03-29
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB103048002080P0008X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program