Provider Demographics
NPI:1821133646
Name:MARANGA, ILYCE (DC)
Entity Type:Individual
Prefix:DR
First Name:ILYCE
Middle Name:
Last Name:MARANGA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 REMSEN ST
Mailing Address - Street 2:SUITE 1103
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4300
Mailing Address - Country:US
Mailing Address - Phone:718-237-4400
Mailing Address - Fax:718-237-2526
Practice Address - Street 1:175 REMSEN ST
Practice Address - Street 2:SUITE 1103
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4300
Practice Address - Country:US
Practice Address - Phone:718-237-4400
Practice Address - Fax:718-237-2526
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006920-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY433612Medicare ID - Type Unspecified
NYX51281Medicare UPIN