MEDICARE: SUSAN MARGARET MARMORATO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	254905-1	NY

General Provider Information

NPI Number	:	1477081388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN MARGARET MARMORATO

Provider Business Mailing Address
First Line	:	11 LINDEN AVE
Second Line	:
City	:	KINGS PARK
State	:	NY
Zip	:	11754
Country	:	US
Telephone Number	:	631-269-5240
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 LINDEN AVENUE
Second Line	:
City	:	KINGS PARK
State	:	NY
Zip	:	11754-1175
Country	:	US
Telephone Number	:	631-269-5240
Fax Number	:	631-269-5240

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2017
Last Update Date	:	05/23/2017

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