Basic Information
Provider Information | |||||||||
NPI: | 1952604373 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KAPOOR | ||||||||
FirstName: | MARIELA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | PEREZ LOZADA | ||||||||
OtherFirstName: | MARIELA | ||||||||
OtherMiddleName: | ELVIRA | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 270 BROADWAY | ||||||||
Address2: |   | ||||||||
City: | LONG BRANCH | ||||||||
State: | NJ | ||||||||
PostalCode: | 077407027 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7329237100 | ||||||||
FaxNumber: | 7329237104 | ||||||||
Practice Location | |||||||||
Address1: | 1901 1ST AVE | ||||||||
Address2: |   | ||||||||
City: | NEW YORK | ||||||||
State: | NY | ||||||||
PostalCode: | 100297404 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2124236262 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/07/2010 | ||||||||
LastUpdateDate: | 03/21/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 259504-6 | NY | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.