MEDICARE: ANTHONY J MARULLO MS,OTR/L

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	174400000X	Specialist	017178-1	NY

General Provider Information

NPI Number	:	1376815456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY J MARULLO MS,OTR/L

Provider Business Mailing Address
First Line	:	868 CHURCH ST STE 4
Second Line	:
City	:	BOHEMIA
State	:	NY
Zip	:	11716-5021
Country	:	US
Telephone Number	:	516-850-4783
Fax Number	:	631-676-4186

Provider Business Practice Location Address
First Line	:	868 CHURCH ST STE 4
Second Line	:
City	:	BOHEMIA
State	:	NY
Zip	:	11716-5021
Country	:	US
Telephone Number	:	631-676-4185
Fax Number	:	631-676-4186

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

Provider Enumeration Date	:	02/03/2012
Last Update Date	:	04/28/2023

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