Provider Demographics
NPI:1124021548
Name:MARRERO, LUIS C (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:C
Last Name:MARRERO
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:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-0279
Mailing Address - Country:US
Mailing Address - Phone:973-773-0100
Mailing Address - Fax:973-773-2101
Practice Address - Street 1:703 MAIN ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2621
Practice Address - Country:US
Practice Address - Phone:973-754-2555
Practice Address - Fax:973-754-2567
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA583172080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6266207Medicaid
NJ6266207Medicaid
NJF82042Medicare UPIN