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NPI Code Detail

MEDICARE: DR. MARINO MESIDOR M.D.

MEDICARE: DR. MARINO MESIDOR M.D.
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
1207R00000XInternal Medicine Physician155000NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518943786
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARINO MESIDOR M.D.
Provider Business Mailing Address
First Line : 170 BIRCHWOOD PARK DR
Second Line :
City : JERICHO
State : NY
Zip : 11753-2206
Country : US
Telephone Number : 516-822-5109
Fax Number :
Provider Business Practice Location Address
First Line : 2094 PITKIN AVE
Second Line : EAST NEW YORK D&TC
City : BROOKLYN
State : NY
Zip : 11207-3509
Country : US
Telephone Number : 718-240-0490
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2005
Last Update Date : 07/08/2007

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