Provider Demographics
NPI:1679662415
Name:MARARENKO, LARISA
Entity Type:Individual
Prefix:DR
First Name:LARISA
Middle Name:
Last Name:MARARENKO
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 1:1 BROOKDALE PLZ
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-3139
Mailing Address - Country:US
Mailing Address - Phone:718-240-7143
Mailing Address - Fax:718-240-5808
Practice Address - Street 1:1335 LINDEN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-4751
Practice Address - Country:US
Practice Address - Phone:718-240-5100
Practice Address - Fax:718-240-5498
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241522207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine