MEDICARE: DR. THOMAS JOHN MARINO O.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
1	152W00000X	Optometrist	NJ 2878	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	521181	OTHER	NJ	MEDICARE PTAN

Other Identifiers

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

General Provider Information

NPI Number	:	1568408839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS JOHN MARINO O.D

Provider Business Mailing Address
First Line	:	1450 PARKSIDE AVE
Second Line	:	SUITE 8
City	:	EWING
State	:	NJ
Zip	:	08638-2946
Country	:	US
Telephone Number	:	609-883-2020
Fax Number	:	609-883-7380

Provider Business Practice Location Address
First Line	:	1450 PARKSIDE AVE
Second Line	:	SUITE 8
City	:	EWING
State	:	NJ
Zip	:	08638-2946
Country	:	US
Telephone Number	:	609-883-2020
Fax Number	:	609-883-7380

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	11/04/2015

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