Healthcare Provider Details

I. General information

NPI: 1558896712
Provider Name (Legal Business Name): MARINA SENIOR CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 MIDLAND AVE
STATEN ISLAND NY
10306-6019
US

IV. Provider business mailing address

17 INEZ ST
STATEN ISLAND NY
10309-3629
US

V. Phone/Fax

Practice location:
  • Phone: 347-777-5731
  • Fax:
Mailing address:
  • Phone: 347-204-8262
  • Fax: 718-668-1004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAHAL FASHI
Title or Position: PRESIDENT
Credential:
Phone: 347-204-8262