Provider Demographics
NPI:1073266920
Name:MANNINO, MARIE
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:
Last Name:MANNINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 SQUIRREL HL
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2843
Mailing Address - Country:US
Mailing Address - Phone:845-641-6442
Mailing Address - Fax:
Practice Address - Street 1:540 N FARVIEW AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-4130
Practice Address - Country:US
Practice Address - Phone:201-343-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY29801-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist