Provider Demographics
NPI:1679015242
Name:BAFATY, MARJORIE (RN)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:BAFATY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 S MAIN ST
Mailing Address - Street 2:125
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-5032
Mailing Address - Country:US
Mailing Address - Phone:732-460-9106
Mailing Address - Fax:732-691-4615
Practice Address - Street 1:30 DEWITT AVE
Practice Address - Street 2:
Practice Address - City:ASBURY PARK
Practice Address - State:NJ
Practice Address - Zip Code:07712-6719
Practice Address - Country:US
Practice Address - Phone:732-460-9106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR15905000172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker