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General NPI Number Information
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NPI Number | 1902209646
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Entity Type | Individual
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Provider Name | MARINA XINOGALOS
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Gender | Female
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Dates
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Enumeration Date | 10/08/2014
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Last Update Date | 04/30/2019
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Provider Practice Location Address
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Address Line | 15022 21ST AVE
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City | WHITESTONE
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State | NY
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Zip | 11357-3608
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Country | US
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Telephone | 718-704-9787
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Fax |
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Provider Business Mailing Address
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Address Line | 15022 21ST AVE
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City | WHITESTONE
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State | NY
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Zip | 11357-3608
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Country | US
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Telephone | 347-494-1643
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number | 939075151
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number | PGP-0654684
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number | 939013151
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License Number State | NY
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