Provider Demographics
NPI:1154508794
Name:MARINA, ADELE (MD)
Entity Type:Individual
Prefix:
First Name:ADELE
Middle Name:
Last Name:MARINA
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 1:330 LIVINGSTON AVE STE 2AA
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-3469
Mailing Address - Country:US
Mailing Address - Phone:732-220-0777
Mailing Address - Fax:732-220-0778
Practice Address - Street 1:330 LIVINGSTON AVE STE 2AA
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-3469
Practice Address - Country:US
Practice Address - Phone:732-220-0777
Practice Address - Fax:732-220-0778
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08459600208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0233544Medicaid