Basic Information
| Provider Information | |||||||||
| NPI: | 1629066949 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SALIL P MARFATIA MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8625 EDGERTON BLVD | ||||||||
| Address2: | |||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114322936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182986575 | ||||||||
| FaxNumber: | 7186571224 | ||||||||
| Practice Location | |||||||||
| Address1: | 9229 QUEENS BLVD | ||||||||
| Address2: | SUITE 1-A | ||||||||
| City: | REGO PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113741056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188975700 | ||||||||
| FaxNumber: | 7188972087 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2005 | ||||||||
| LastUpdateDate: | 02/15/2008 | ||||||||
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| AuthorizedOfficialLastName: | MARFATIA | ||||||||
| AuthorizedOfficialFirstName: | SALIL | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7188975700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 185108 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 006AS1 | 01 | NY | BLUE CROSS BLUE SHIELD | OTHER | 01366930 | 05 | NY | MEDICAID | 2503394 | 01 | NY | GHI | OTHER |