Provider Demographics
NPI:1053445031
Name:MARINELLI, LEAH (CNM)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:
Last Name:MARINELLI
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-1708
Mailing Address - Country:US
Mailing Address - Phone:845-641-5058
Mailing Address - Fax:
Practice Address - Street 1:3 SCENIC DR
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-1708
Practice Address - Country:US
Practice Address - Phone:845-641-5058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000977176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02383017Medicaid
NY02383017Medicaid