Individual
ISMENE N. MARAVEGIAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
400 CAROLINE ST, OGDENSBURG, NY 13669-2602
(315) 212-0144
Mailing address
307 S EVERGREEN AVE, WOODBURY, NJ 08096-2739
(856) 686-4300
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
217757
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
223594884
EXCELLUS BCBS
NY
01
—
223594884008
CHAMPUS/TRICARE
NY
Enumeration date
05/26/2006
Last updated
04/26/2016
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