Provider Demographics
NPI:1720434475
Name:MAJZOUB, MARIAM (MBBCH)
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:MAJZOUB
Suffix:
Gender:F
Credentials:MBBCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 SEAVIEW AVENUE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305
Mailing Address - Country:US
Mailing Address - Phone:718-226-6205
Mailing Address - Fax:718-226-8695
Practice Address - Street 1:475 SEAVIEW AVENUE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305
Practice Address - Country:US
Practice Address - Phone:718-226-6205
Practice Address - Fax:718-226-8695
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2018-05-09
Deactivation Date:2017-01-05
Deactivation Code:
Reactivation Date:2018-05-09
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program