Provider Demographics
NPI:1689937716
Name:SHIFRIN, MARINA (MSED/TSHH)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:SHIFRIN
Suffix:
Gender:F
Credentials:MSED/TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 75TH ST APT 108
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-4426
Mailing Address - Country:US
Mailing Address - Phone:718-639-9032
Mailing Address - Fax:718-639-9032
Practice Address - Street 1:3515 75TH ST APT 108
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-4426
Practice Address - Country:US
Practice Address - Phone:917-518-4100
Practice Address - Fax:718-639-9032
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY088022011174400000X
NY160773021174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist