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NPI Code Detail

MEDICARE: MR. THOMAS STEPHEN MARINO PA-C

MEDICARE: MR. THOMAS STEPHEN MARINO PA-C
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
1363AM0700XMedical Physician Assistant008353NY

General Provider Information

NPI Number : 1619978806
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. THOMAS STEPHEN MARINO PA-C
Provider Business Mailing Address
First Line : 5 CHELSEA DR
Second Line :
City : NORTH MERRICK
State : NY
Zip : 11566-2005
Country : US
Telephone Number : 516-804-6210
Fax Number :
Provider Business Practice Location Address
First Line : 123 W 124TH ST
Second Line : HARLEM UNITED COMMUNITY AIDS CENTER
City : NEW YORK
State : NY
Zip : 10027-4920
Country : US
Telephone Number : 212-531-1300
Fax Number : 212-531-1085
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2005
Last Update Date : 05/05/2011

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