Provider Demographics
NPI:1114928165
Name:MARINIS, WILLIAM K (PA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:K
Last Name:MARINIS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 COUNTY ROUTE 47
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-5405
Mailing Address - Country:US
Mailing Address - Phone:518-891-2688
Mailing Address - Fax:518-891-4120
Practice Address - Street 1:309 COUNTY ROUTE 47
Practice Address - Street 2:SUITE 1
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-5405
Practice Address - Country:US
Practice Address - Phone:518-891-2688
Practice Address - Fax:518-891-4120
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004181363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS67551Medicare UPIN
NYPA2703Medicare PIN