Provider Demographics
NPI:1972847440
Name:TABORGA, MARCELO (MD)
Entity type:Individual
Prefix:DR
First Name:MARCELO
Middle Name:
Last Name:TABORGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 E 6TH ST APT 20A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-6420
Mailing Address - Country:US
Mailing Address - Phone:917-687-4856
Mailing Address - Fax:
Practice Address - Street 1:3096 51ST ST
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-1457
Practice Address - Country:US
Practice Address - Phone:718-204-1469
Practice Address - Fax:718-545-1726
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-21
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY324905207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine