Provider Demographics
NPI:1629066949
Name:SALIL P MARFATIA MD PC
Entity Type:Organization
Organization Name:SALIL P MARFATIA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALIL
Authorized Official - Middle Name:P
Authorized Official - Last Name:MARFATIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-897-5700
Mailing Address - Street 1:8625 EDGERTON BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2936
Mailing Address - Country:US
Mailing Address - Phone:718-298-6575
Mailing Address - Fax:718-657-1224
Practice Address - Street 1:9229 QUEENS BLVD
Practice Address - Street 2:SUITE 1-A
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1056
Practice Address - Country:US
Practice Address - Phone:718-897-5700
Practice Address - Fax:718-897-2087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185108207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01366930Medicaid
NY2503394OtherGHI
NY006AS1OtherBLUE CROSS BLUE SHIELD
NY01078Medicare PIN
NY01366930Medicaid