Provider Demographics
NPI:1508610288
Name:MARQUEZ MEJIA, CHENSY EIDI (PI)
Entity type:Individual
Prefix:
First Name:CHENSY
Middle Name:EIDI
Last Name:MARQUEZ MEJIA
Suffix:
Gender:F
Credentials:PI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4761 BROADWAY APT 2K
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-4911
Mailing Address - Country:US
Mailing Address - Phone:347-951-2416
Mailing Address - Fax:
Practice Address - Street 1:4761 BROADWAY APT 2K
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-4911
Practice Address - Country:US
Practice Address - Phone:347-951-2416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2708363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant