Healthcare Provider Details

I. General information

NPI: 1689902058
Provider Name (Legal Business Name): LEONARD N MARINO DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2009
Last Update Date: 11/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1292 VICTORY BLVD
STATEN ISLAND NY
10301-3904
US

IV. Provider business mailing address

1292 VICTORY BLVD
STATEN ISLAND NY
10301
US

V. Phone/Fax

Practice location:
  • Phone: 718-816-9000
  • Fax:
Mailing address:
  • Phone: 718-816-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number007221
License Number StateNY

VIII. Authorized Official

Name: DR. LEONARD NICHOLAS MARINO
Title or Position: PRESIDENT
Credential: DC
Phone: 718-816-9000