Provider Demographics
NPI:1699095406
Name:MARZOUK, ELIE (DDS)
Entity type:Individual
Prefix:DR
First Name:ELIE
Middle Name:
Last Name:MARZOUK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4913 VERNON BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5725
Mailing Address - Country:US
Mailing Address - Phone:718-392-4982
Mailing Address - Fax:718-392-4022
Practice Address - Street 1:4913 VERNON BLVD
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5725
Practice Address - Country:US
Practice Address - Phone:718-392-4982
Practice Address - Fax:718-392-4022
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038945122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist