Basic Information
| Provider Information | |||||||||
| NPI: | 1235217621 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORBAN | ||||||||
| FirstName: | MARISOL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 BRYANT CRES | ||||||||
| Address2: | 2M | ||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106052640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9174786115 | ||||||||
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| Practice Location | |||||||||
| Address1: | 30 S BROADWAY | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107013712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149684898 | ||||||||
| FaxNumber: | 9149685496 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 009933 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.