Provider Demographics
NPI:1205835790
Name:MARRERO, GINA MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:MARIA
Last Name:MARRERO
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 1:444 MERRICK RD STE LL2
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2400
Mailing Address - Country:US
Mailing Address - Phone:516-599-4242
Mailing Address - Fax:516-599-4449
Practice Address - Street 1:444 MERRICK RD STE LL2
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2400
Practice Address - Country:US
Practice Address - Phone:516-599-4242
Practice Address - Fax:516-599-4449
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205926-1207N00000X, 207NS0135X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01886828Medicaid
NY07U011Medicare ID - Type Unspecified
NYG67047Medicare UPIN