MEDICARE: DR. SHANNON MARINIELLO DC

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	111N00000X	Chiropractor	38MC00505700	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1996718	OTHER	NJ	UNITED HEALTHCARE
2	31356	OTHER	NJ	MASTERCARE
3	5899591	OTHER	NJ	GHI
4	5936399004	OTHER	NJ	CIGNA
5	X2D241	OTHER	NJ	EMPIRE
6	1047999	OTHER	NJ	AETNA HMO
7	050005057NJ01	OTHER	NJ	ANTHEM HEALTH
8	0798375000	OTHER	NJ	AMERIHEALTH
9	96301	OTHER	NJ	AMERIGROUP
10	1126013	OTHER	NJ	HORIZON NJ HEALTH
11	5362694	OTHER	NJ	AETNA
12	5362694	OTHER	NJ	AETNA PPO
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	24878	OTHER	NJ	UNIVERSITY HEALTH PLANS
15	P2084184	OTHER	NJ	OXFORD

General Provider Information

NPI Number	:	1770561490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNON MARINIELLO DC

Provider Business Mailing Address
First Line	:	517 RIVER DR STE 2A
Second Line	:
City	:	GARFIELD
State	:	NJ
Zip	:	07026-3270
Country	:	US
Telephone Number	:	973-955-0755
Fax Number	:	973-955-0753

Provider Business Practice Location Address
First Line	:	517 RIVER DR STE 2A
Second Line	:
City	:	GARFIELD
State	:	NJ
Zip	:	07026-3270
Country	:	US
Telephone Number	:	973-955-0755
Fax Number	:	973-955-0753

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

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	07/21/2022

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Directions to “ DR. SHANNON MARINIELLO DC” Practice Location

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