Provider Demographics
NPI:1154863470
Name:VEGA, MARLENE
Entity Type:Individual
Prefix:MRS
First Name:MARLENE
Middle Name:
Last Name:VEGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 PELHAM PAKWAY SOUTH
Mailing Address - Street 2:APT 5E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461
Mailing Address - Country:US
Mailing Address - Phone:917-817-6744
Mailing Address - Fax:
Practice Address - Street 1:1144 PELHAM PKWY S
Practice Address - Street 2:APT 5E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1012
Practice Address - Country:US
Practice Address - Phone:917-817-6744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator