Provider Demographics
NPI:1578566436
Name:MARZIALE, JENNIFER C (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:MARZIALE
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4850 BROAD RD
Mailing Address - Street 2:STE 2C
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-5103
Mailing Address - Country:US
Mailing Address - Phone:315-492-5915
Mailing Address - Fax:315-492-5210
Practice Address - Street 1:4850 BROAD RD
Practice Address - Street 2:STE 2C
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-5103
Practice Address - Country:US
Practice Address - Phone:315-492-5915
Practice Address - Fax:315-492-5210
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY222477207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H58276Medicare UPIN