Provider Demographics
NPI:1295032050
Name:MARZEC, TERESA CASCIANO (BS)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:CASCIANO
Last Name:MARZEC
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 DEERHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-3801
Mailing Address - Country:US
Mailing Address - Phone:845-247-0787
Mailing Address - Fax:
Practice Address - Street 1:41 DEERHAVEN LN
Practice Address - Street 2:
Practice Address - City:SAUGERTIES
Practice Address - State:NY
Practice Address - Zip Code:12477-3801
Practice Address - Country:US
Practice Address - Phone:845-247-0787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006071-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006071-1Medicaid
NY00671-1Medicaid