MEDICARE: MARISA MARINARO

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1962921866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISA MARINARO

Provider Business Mailing Address
First Line	:	741 ANNADALE RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-3110
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 SOUTH AVE STE 405
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3411
Country	:	US
Telephone Number	:	718-556-1616
Fax Number	:

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

Provider Enumeration Date	:	09/12/2017
Last Update Date	:	03/17/2018

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