Provider Demographics
NPI:1497048151
Name:UNITED STATES MARINE CORPS
Entity Type:Organization
Organization Name:UNITED STATES MARINE CORPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MILITARY
Authorized Official - Prefix:MR
Authorized Official - First Name:ERWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEMBRENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-938-0696
Mailing Address - Street 1:2488 GRAND CONCOURSE RM 204
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-5207
Mailing Address - Country:US
Mailing Address - Phone:718-938-0696
Mailing Address - Fax:718-367-6212
Practice Address - Street 1:2488 GRAND CONCOURSE RM 204
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5207
Practice Address - Country:US
Practice Address - Phone:718-938-0696
Practice Address - Fax:718-367-6212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital