Healthcare Provider Details

I. General information

NPI: 1609867944
Provider Name (Legal Business Name): ALEJANDRO T MARIANO PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 COLUMBUS AVE
STATEN ISLAND NY
10304-4325
US

IV. Provider business mailing address

2535 ARTHUR KILL RD
STATEN ISLAND NY
10309-1207
US

V. Phone/Fax

Practice location:
  • Phone: 718-448-3210
  • Fax: 718-816-7417
Mailing address:
  • Phone: 718-448-3210
  • Fax: 718-984-2642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number0103951
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number0103951
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0103951
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: