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Individual
MARYANNE E MODRAK
Active
Individual
MARYANNE E MODRAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
162487-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01025754
—
NY
Enumeration date
08/24/2005
Last updated
12/09/2015
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