Provider Demographics
NPI:1982040226
Name:JULIO E ALBARRAN MARZAN MD PC
Entity Type:Organization
Organization Name:JULIO E ALBARRAN MARZAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:E
Authorized Official - Last Name:ALBARRAN MARZAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-781-8088
Mailing Address - Street 1:254 ORANGEBURGH RD
Mailing Address - Street 2:
Mailing Address - City:OLD TAPPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-7408
Mailing Address - Country:US
Mailing Address - Phone:212-781-8088
Mailing Address - Fax:212-320-0282
Practice Address - Street 1:452 FORT WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-4600
Practice Address - Country:US
Practice Address - Phone:212-781-8088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181719305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01410544Medicaid
NYJA02L1110OtherMEDICARE
NY01410544Medicaid