Provider Demographics
NPI:1346421708
Name:CARUSO, MARCO (DC)
Entity Type:Individual
Prefix:
First Name:MARCO
Middle Name:
Last Name:CARUSO
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 1:83 MONTGOMERY AVE
Mailing Address - Street 2:FLOOR 1
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-5104
Mailing Address - Country:US
Mailing Address - Phone:914-961-7575
Mailing Address - Fax:914-961-8489
Practice Address - Street 1:83 MONTGOMERY AVE
Practice Address - Street 2:FLOOR 1
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5104
Practice Address - Country:US
Practice Address - Phone:914-961-7575
Practice Address - Fax:914-961-8489
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010167-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX4H491Medicare PIN