Provider Demographics
NPI:1336208685
Name:ALEX J MARBAN MD PA
Entity Type:Organization
Organization Name:ALEX J MARBAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:PADRON
Authorized Official - Last Name:BESU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-557-0642
Mailing Address - Street 1:290 WEST 49TH STREET
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3763
Mailing Address - Country:US
Mailing Address - Phone:305-557-0642
Mailing Address - Fax:305-557-1578
Practice Address - Street 1:290 W 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3763
Practice Address - Country:US
Practice Address - Phone:305-557-0642
Practice Address - Fax:305-557-1578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0072806174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAF710Medicare PIN
FLG58754Medicare UPIN