Provider Demographics
NPI:1124167622
Name:MARFATIA, SALIL
Entity type:Individual
Prefix:DR
First Name:SALIL
Middle Name:
Last Name:MARFATIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9229 QUEENS BLVD
Mailing Address - Street 2:STE 1A
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1099
Mailing Address - Country:US
Mailing Address - Phone:718-897-5700
Mailing Address - Fax:
Practice Address - Street 1:9229 QUEENS BLVD
Practice Address - Street 2:SUITE 1A
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1056
Practice Address - Country:US
Practice Address - Phone:718-670-5580
Practice Address - Fax:718-897-2087
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185108207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF39160Medicare UPIN