MEDICARE: MR. SAM MICHAEL MARIANI LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172M00000X	Mechanotherapist	014443-1	NY

General Provider Information

NPI Number	:	1205118007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SAM MICHAEL MARIANI LMT

Provider Business Mailing Address
First Line	:	3203 20TH RD
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11105-2020
Country	:	US
Telephone Number	:	516-398-0884
Fax Number	:

Provider Business Practice Location Address
First Line	:	3203 20TH RD
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11105-2020
Country	:	US
Telephone Number	:	516-398-0884
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2011
Last Update Date	:	09/24/2013

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