Individual
MARYNA MOOTOO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4802 10TH AVE, BROOKLYN, NY 11219-2916
(718) 283-8958
Mailing address
35 OLIVER ST APT 5G, BROOKLYN, NY 11209-6585
(347) 545-7771
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
019123
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000057
BLUE CROSS
NY
01
—
000502001
AMERICHOICE
—
01
—
0007008
AETNAUSHEALTHCARE
—
05
—
02998736
—
NY
01
—
71002
ELDERPLAN
—
01
—
HO4400
OXFORD
—
01
—
IC0023
PHYSICIANS HEALTH
—
Enumeration date
10/09/2015
Last updated
03/08/2021
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