Provider Demographics
NPI:1275604365
Name:MARINI, CORRADO P (MD)
Entity Type:Individual
Prefix:
First Name:CORRADO
Middle Name:P
Last Name:MARINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 MINEOLA BLVD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2528
Mailing Address - Country:US
Mailing Address - Phone:516-663-1145
Mailing Address - Fax:516-877-2440
Practice Address - Street 1:173 MINEOLA BLVD
Practice Address - Street 2:SUITE 401
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2528
Practice Address - Country:US
Practice Address - Phone:516-663-1145
Practice Address - Fax:516-877-2440
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY141055208600000X, 2086S0102X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00812419Medicaid
NY00812419Medicaid