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Individual
MARVIN ALEXANDER BURGOS
Active
Individual
MARVIN ALEXANDER BURGOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
909992
NY
246ZC0007X
Surgical Assistant
246ZC0007X
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FV47428W
FIDELISCARE
NY
01
—
W284879900
AETNA
NY
Enumeration date
12/08/2016
Last updated
06/10/2024
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