Provider Demographics
NPI:1922559608
Name:MARRERO, JADICA ALEXIS (PARAPROFESSIONAL)
Entity Type:Individual
Prefix:
First Name:JADICA
Middle Name:ALEXIS
Last Name:MARRERO
Suffix:
Gender:F
Credentials:PARAPROFESSIONAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 EINSTEIN LOOP APT 23G
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4948
Mailing Address - Country:US
Mailing Address - Phone:929-233-4490
Mailing Address - Fax:
Practice Address - Street 1:100 EINSTEIN LOOP APT 23G
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4948
Practice Address - Country:US
Practice Address - Phone:929-233-4490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY984670396OtherIDENTIFICATION CARD
NYJUN90010T01OtherEMBLEM HIP