Provider Demographics
NPI:1710986039
Name:MARINA, ZAHRA (MD)
Entity Type:Individual
Prefix:
First Name:ZAHRA
Middle Name:
Last Name:MARINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1582 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1529
Mailing Address - Country:US
Mailing Address - Phone:718-761-0623
Mailing Address - Fax:718-761-0769
Practice Address - Street 1:1582 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1529
Practice Address - Country:US
Practice Address - Phone:718-761-0623
Practice Address - Fax:718-761-0769
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221453208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02165864Medicaid
H43473Medicare UPIN