Healthcare Provider Details

I. General information

NPI: 1770806432
Provider Name (Legal Business Name): DIEGO A MARMANILLO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2010
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E MAIN ST
MIDDLETOWN NY
10940-2577
US

IV. Provider business mailing address

35 RED BARN RD
PINE BUSH NY
12566-7457
US

V. Phone/Fax

Practice location:
  • Phone: 845-344-0444
  • Fax: 845-344-0456
Mailing address:
  • Phone: 845-807-3768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number011789
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: