Healthcare Provider Details

I. General information

NPI: 1780299602
Provider Name (Legal Business Name): MARIANNE MAGNO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MINEOLA BLVD FL 2
MINEOLA NY
11501-4089
US

IV. Provider business mailing address

5718 WOODSIDE AVE STE 101
WOODSIDE NY
11377-3400
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-3511
  • Fax:
Mailing address:
  • Phone: 917-476-5036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number693511
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number346606
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: