Provider Demographics
NPI:1568202620
Name:ISLAS-MARROQUIN, JOSE S (MS)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:S
Last Name:ISLAS-MARROQUIN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 CRYSTAL RUN RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-4073
Mailing Address - Country:US
Mailing Address - Phone:856-776-1263
Mailing Address - Fax:
Practice Address - Street 1:384 CRYSTAL RUN RD STE 102
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-4073
Practice Address - Country:US
Practice Address - Phone:856-776-1263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist