Modrak, Maryanne E
Modrak, Maryanne E is an individual health care provider with primary practice located at 507 Main St , Johnson City NY 13790-1810. She recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as her primary health care specialty. Modrak, Maryanne E can be contacted via phone (607) 763-8008.Contact Information
Primary practice address
507 Main St
Johnson City NY 13790-1810
Phone: (607) 763-8008
Fax: (607) 763-8019
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 162487-1 | New York |
Profile Details
| NPI number | 1790778876 |
|---|---|
| LBN Legal business name | Modrak, Maryanne E |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 24th, 2005 |
| Last updated | Dec 9th, 2015 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1790778876 | NPPES |
| New York | MEDICAID | 01025754 |
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