Organization
MARIAN MEDICAL CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS MARIAVIDA TUPAZ TECSON MD (OWNER PHYSICIAN)
(973) 921-9321
Entity
Organization
Contact information
Practice address
116 MILLBURN AVENUE, SUITE 207, MILLBURN, NJ 07041-1919
(973) 921-9321
(973) 921-9323
Mailing address
116 MILLBURN AVENUE, SUITE 207, MILLBURN, NJ 07041-1919
(973) 921-9321
(973) 921-9323
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
25MA0747600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0047031
—
NJ
01
—
2540897
UNITED HEALTHCARE
NJ
01
—
2K7666
HEALTHNET
NJ
01
—
7135641 3631135
AETNA
NJ
01
—
P3469886
OXFORD
NJ
Enumeration date
06/30/2008
Last updated
06/30/2008
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