Provider Demographics
NPI:1104902311
Name:MARIN, DEBORAH BLUMENTHAL (MD)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:BLUMENTHAL
Last Name:MARIN
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1 GUSTAVE L LEVY PLACE
Mailing Address - Street 2:BOX 1230
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6574
Mailing Address - Country:US
Mailing Address - Phone:212-241-7139
Mailing Address - Fax:212-849-2441
Practice Address - Street 1:1 GUSTAVE L LEVY PL
Practice Address - Street 2:BOX 1230
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6500
Practice Address - Country:US
Practice Address - Phone:212-241-7139
Practice Address - Fax:212-849-2441
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2008-09-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1653022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01647447Medicaid
NYE87370Medicare UPIN
NY01647447Medicaid