Healthcare Provider Details

I. General information

NPI: 1063100196
Provider Name (Legal Business Name): PIETRO MAROTTA PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1989 CONEY ISLAND AVE
BROOKLYN NY
11223-2328
US

IV. Provider business mailing address

30 HAZELWOOD AVE
WESTHAMPTON BEACH NY
11978-1405
US

V. Phone/Fax

Practice location:
  • Phone: 516-940-7360
  • Fax:
Mailing address:
  • Phone: 631-902-4827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number013368
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: