Provider Demographics
NPI:1699418434
Name:TUBA, MARYAM
Entity type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:TUBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 W 38TH ST RM 817
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-2913
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:212-695-4564
Practice Address - Street 1:307 W 38TH ST RM 817
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-2913
Practice Address - Country:US
Practice Address - Phone:212-695-4564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker