Provider Demographics
NPI:1245478189
Name:MARMOR, RACHEL
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:MARMOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 W 69TH ST
Mailing Address - Street 2:APT 51
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5107
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 W 69TH ST
Practice Address - Street 2:APT 51
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5107
Practice Address - Country:US
Practice Address - Phone:516-562-4525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02471000122300000X
NY054509122300000X
WV4665122300000X
CT013595122300000X
CADDS60803122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist