Provider Demographics
NPI:1164597159
Name:MARINO, VINCENT ANTHONY (DC)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:ANTHONY
Last Name:MARINO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 GETZ AVENUE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-2177
Mailing Address - Country:US
Mailing Address - Phone:718-984-2620
Mailing Address - Fax:
Practice Address - Street 1:2026 68TH STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-4563
Practice Address - Country:US
Practice Address - Phone:718-234-8980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0062811111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX45172OtherEMPIRE BCBS
NYX45171Medicare ID - Type Unspecified