Provider Demographics
NPI:1164573036
Name:LANDICHO, MARILYN RONGO (NP)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:RONGO
Last Name:LANDICHO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 PENN PLAZA, 7TH FL. STE. 725
Mailing Address - Street 2:EVERCARE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10119
Mailing Address - Country:US
Mailing Address - Phone:212-216-6793
Mailing Address - Fax:212-216-6606
Practice Address - Street 1:1 PENN PLAZA, 7TH FL. STE. 725
Practice Address - Street 2:EVERCARE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10119
Practice Address - Country:US
Practice Address - Phone:212-216-6793
Practice Address - Fax:212-216-6606
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY334063363LF0000X
NYF1103327363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily