Provider Demographics
NPI:1073915260
Name:MARIANO, MARYBETH (APN)
Entity Type:Individual
Prefix:
First Name:MARYBETH
Middle Name:
Last Name:MARIANO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:MARYBETH
Other - Middle Name:
Other - Last Name:PALMIERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:30 PROSPECT AVE
Mailing Address - Street 2:AUDREY HEPBURN CHILDREN'S HOUSE
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1914
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 PROSPECT AVE
Practice Address - Street 2:AUDREY HEPBURN CHILDREN'S HOUSE
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1914
Practice Address - Country:US
Practice Address - Phone:551-996-2271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00400900363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics