Provider Demographics
NPI:1407129000
Name:MARRERO, LUISA MARIA (LMT)
Entity Type:Individual
Prefix:MISS
First Name:LUISA
Middle Name:MARIA
Last Name:MARRERO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8406 109TH ST
Mailing Address - Street 2:9E
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-1258
Mailing Address - Country:US
Mailing Address - Phone:191-735-3119
Mailing Address - Fax:
Practice Address - Street 1:220 MADISON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3422
Practice Address - Country:US
Practice Address - Phone:212-684-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023878225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist