Provider Demographics
NPI:1376815456
Name:MARULLO, ANTHONY J (MS,OTR/L)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:MARULLO
Suffix:
Gender:M
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:868 CHURCH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-5021
Mailing Address - Country:US
Mailing Address - Phone:516-850-4783
Mailing Address - Fax:631-676-4186
Practice Address - Street 1:868 CHURCH ST STE 4
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-5021
Practice Address - Country:US
Practice Address - Phone:631-676-4185
Practice Address - Fax:631-676-4186
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017178-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist