Provider Demographics
NPI:1083939847
Name:DEMARCO, MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:DEMARCO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 TERRY BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-5747
Mailing Address - Country:US
Mailing Address - Phone:631-327-4275
Mailing Address - Fax:631-563-1074
Practice Address - Street 1:4844 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-1011
Practice Address - Country:US
Practice Address - Phone:631-327-2475
Practice Address - Fax:631-563-1074
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023642225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist