Provider Demographics
NPI:1255056396
Name:RAMNANAN-JAIKARAN, MARLENE
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:RAMNANAN-JAIKARAN
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 1:230 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-3704
Mailing Address - Country:US
Mailing Address - Phone:718-938-3644
Mailing Address - Fax:
Practice Address - Street 1:230 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-3704
Practice Address - Country:US
Practice Address - Phone:718-938-3644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF350338-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily