Basic Information
| Provider Information | |||||||||
| NPI: | 1588212070 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARIN | ||||||||
| FirstName: | JASMINE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 845 N BROADWAY | ||||||||
| Address2: | |||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106032403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147610600 | ||||||||
| FaxNumber: | 9147615367 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 ODELL PLZ STE 1 | ||||||||
| Address2: | |||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107011402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142376089 | ||||||||
| FaxNumber: | 9142376099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2019 | ||||||||
| LastUpdateDate: | 08/28/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.