Provider Demographics
NPI:1205831724
Name:MARIANI, RAYMOND E (OD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:E
Last Name:MARIANI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 EAST GATE BLVD
Mailing Address - Street 2:STE 111
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530
Mailing Address - Country:US
Mailing Address - Phone:516-804-5200
Mailing Address - Fax:516-240-6540
Practice Address - Street 1:2000 N VILLAGE AVE
Practice Address - Street 2:STE 402
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-1001
Practice Address - Country:US
Practice Address - Phone:516-766-2519
Practice Address - Fax:516-766-3714
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT005270152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01350825Medicaid
NY01350825Medicaid
NYC499138261Medicare UPIN