Provider Demographics
NPI:1114209202
Name:MARBALLI, ARUNDHATI (MD)
Entity Type:Individual
Prefix:
First Name:ARUNDHATI
Middle Name:
Last Name:MARBALLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6317 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-4922
Mailing Address - Country:US
Mailing Address - Phone:718-907-8100
Mailing Address - Fax:718-492-5090
Practice Address - Street 1:6317 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-4922
Practice Address - Country:US
Practice Address - Phone:718-907-8100
Practice Address - Fax:718-492-5090
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY262772207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine