Provider Demographics
NPI:1932160603
Name:MARKOWSKI, MARYANNE (CNM)
Entity type:Individual
Prefix:
First Name:MARYANNE
Middle Name:
Last Name:MARKOWSKI
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 HARDING ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-1217
Mailing Address - Country:US
Mailing Address - Phone:908-672-4757
Mailing Address - Fax:973-926-8439
Practice Address - Street 1:201 LYONS AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107
Practice Address - Country:US
Practice Address - Phone:973-926-7112
Practice Address - Fax:973-926-8439
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00037401367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1666401Medicaid