Provider Demographics
NPI:1265540595
Name:MARCHIONE, VICTOR (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:MARCHIONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PMB 204
Mailing Address - Street 2:123 TOWN SQ PLACE
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310
Mailing Address - Country:US
Mailing Address - Phone:201-376-3092
Mailing Address - Fax:201-210-2185
Practice Address - Street 1:600 PAVONIA AVE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306
Practice Address - Country:US
Practice Address - Phone:201-216-0744
Practice Address - Fax:201-216-0844
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA03917200207R00000X
NJMA39172207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ803328Medicare PIN
NJD19649Medicare UPIN