MEDICARE: JOSEPH MARINO MD

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	207W00000X	Ophthalmology Physician	110734	NY

General Provider Information

NPI Number	:	1619086873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH MARINO MD

Provider Business Mailing Address
First Line	:	2242 CENTRAL PARK AVENUE
Second Line	:
City	:	YONKERS
State	:	NY
Zip	:	10710
Country	:	US
Telephone Number	:	914-793-7111
Fax Number	:

Provider Business Practice Location Address
First Line	:	2242 CENTRAL PARK AVENUE
Second Line	:
City	:	YONKERS
State	:	NY
Zip	:	10710
Country	:	US
Telephone Number	:	914-793-7111
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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