Provider Demographics
NPI:1316554892
Name:MARDER, BELLA
Entity Type:Individual
Prefix:
First Name:BELLA
Middle Name:
Last Name:MARDER
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 1:357 E 57TH ST FRNT 1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2907
Mailing Address - Country:US
Mailing Address - Phone:212-230-1899
Mailing Address - Fax:
Practice Address - Street 1:357 E 57TH ST FRNT 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2907
Practice Address - Country:US
Practice Address - Phone:212-230-1899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY672325-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty