Healthcare Provider Details

I. General information

NPI: 1538163803
Provider Name (Legal Business Name): JOHN STEVEN MARINO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1999 MARCUS AVE SUITE 300
NEW HYDE PARK NY
11042-1033
US

IV. Provider business mailing address

1999 MARCUS AVE SUITE 300
NEW HYDE PARK NY
11042-1033
US

V. Phone/Fax

Practice location:
  • Phone: 516-883-0122
  • Fax: 516-883-2507
Mailing address:
  • Phone: 516-883-0122
  • Fax: 516-883-2507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number143453
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: