Provider Demographics
NPI:1750468021
Name:MANRIQUE, MARINA OSORES (MD)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:OSORES
Last Name:MANRIQUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 S VIRGINIA CT
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2117
Mailing Address - Country:US
Mailing Address - Phone:201-567-5149
Mailing Address - Fax:
Practice Address - Street 1:8209 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7034
Practice Address - Country:US
Practice Address - Phone:718-507-8000
Practice Address - Fax:718-205-0871
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60193791207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine