Marian Medical Clinic PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

25MA0747600 Issued in NJ

Legal business name

MARIAN MEDICAL CLINIC PC

Practice address

116 Millburn Avenue
Suite 207
Millburn, NJ 07041-1919

Phone

(973) 921-9321

Fax

(973) 921-9323

NPI assigned

Jun 30, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Miss Mariavida Tupaz Tecson, MD

Title

Owner Physician

Phone

(973) 921-9321

Specialties & licenses 1

Addresses

Other identifiers 5

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214784000000",
    "number": "1730341801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 MILLBURN AVENUE",
            "address_2": "SUITE 207",
            "city": "MILLBURN",
            "state": "NJ",
            "postal_code": "070411919",
            "telephone_number": "973-921-9321",
            "fax_number": "973-921-9323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 MILLBURN AVENUE",
            "address_2": "SUITE 207",
            "city": "MILLBURN",
            "state": "NJ",
            "postal_code": "070411919",
            "telephone_number": "973-921-9321",
            "fax_number": "973-921-9323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIAN MEDICAL CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-30",
        "last_updated": "2008-06-30",
        "status": "A",
        "authorized_official_last_name": "TECSON",
        "authorized_official_first_name": "MARIAVIDA",
        "authorized_official_middle_name": "TUPAZ",
        "authorized_official_title_or_position": "OWNER PHYSICIAN",
        "authorized_official_telephone_number": "973-921-9321",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NJ",
            "license": "25MA0747600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P3469886",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0047031",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "2540897",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7135641 3631135",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "2K7666",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William J Malta, D.C.
• Subita S Mangru, M.D.
• John Manicone
• Mark Jonathan Mann, MD
• Maplewood Foot and Ankle
• Maureen Broderick Wilhelm LPT PA
• Maureen Broderick Wilhelm, LPT, PA
• Gail Holly Mautner, MD
• Frieda L Max, DMD
• Yilda Limary Mayo, M.D.

• Specialist in Millburn, NJ
• Providers in Millburn, NJ by specialty
• Specialist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.