Provider Demographics
NPI:1922075365
Name:JBARA, MARLENA E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARLENA
Middle Name:E
Last Name:JBARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARLENA
Other - Middle Name:E
Other - Last Name:PURSNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2777 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306
Mailing Address - Country:US
Mailing Address - Phone:718-979-0100
Mailing Address - Fax:718-979-3602
Practice Address - Street 1:2777 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306
Practice Address - Country:US
Practice Address - Phone:718-979-0100
Practice Address - Fax:718-979-3602
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20815712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02165337Medicaid
H53394Medicare UPIN
NY02165337Medicaid