Healthcare Provider Details

I. General information

NPI: 1275604365
Provider Name (Legal Business Name): CORRADO P MARINI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 12/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 MINEOLA BLVD SUITE 401
MINEOLA NY
11501-2528
US

IV. Provider business mailing address

173 MINEOLA BLVD SUITE 401
MINEOLA NY
11501-2528
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-1145
  • Fax: 516-877-2440
Mailing address:
  • Phone: 516-663-1145
  • Fax: 516-877-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number141055
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number141055
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number141055
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: