Provider Demographics
NPI:1225145394
Name:MARABELLA, SAMUEL L JR (PT)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:L
Last Name:MARABELLA
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120
Mailing Address - Country:US
Mailing Address - Phone:716-692-6388
Mailing Address - Fax:716-692-1227
Practice Address - Street 1:105 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120
Practice Address - Country:US
Practice Address - Phone:716-692-6388
Practice Address - Fax:716-692-1227
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002388225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00020519201OtherUNIVERA
000604453001OtherBCBS
NY0066615Medicaid
9351528OtherINDEPENDENT HEALTH
044531Medicare ID - Type Unspecified