Healthcare Provider Details

I. General information

NPI: 1972573434
Provider Name (Legal Business Name): VICTOR MARINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 WESTCHESTER AVE
WHITE PLAINS NY
10604-2901
US

IV. Provider business mailing address

210 WESTCHESTER AVE 3RD FLOOR
WHITE PLAINS NY
10604-2901
US

V. Phone/Fax

Practice location:
  • Phone: 914-682-0700
  • Fax: 914-682-6403
Mailing address:
  • Phone: 914-681-3146
  • Fax: 914-682-6403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA175666-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: