Healthcare Provider Details

I. General information

NPI: 1730199258
Provider Name (Legal Business Name): HENRY MARANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 01/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 MEETING HOUSE LANE
SOUTH HAMPTON NY
11968
US

IV. Provider business mailing address

635 BELLE TERRE RD SUITE #204
PORT JEFFERSON NY
11777-1935
US

V. Phone/Fax

Practice location:
  • Phone: 631-283-0355
  • Fax: 631-283-2084
Mailing address:
  • Phone: 631-474-0008
  • Fax: 631-474-0224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number171961-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: