Provider Demographics
NPI:1174715833
Name:MARENBERG, STANFORD P (PHD)
Entity type:Individual
Prefix:DR
First Name:STANFORD
Middle Name:P
Last Name:MARENBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 VIVIGEN WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5600
Mailing Address - Country:US
Mailing Address - Phone:505-438-2156
Mailing Address - Fax:
Practice Address - Street 1:2000 VIVIGEN WAY
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5600
Practice Address - Country:US
Practice Address - Phone:505-438-2156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCQP35863207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine