Provider Demographics
NPI:1417376161
Name:ALTINO, MARJORIE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:MARJORIE
Middle Name:
Last Name:ALTINO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 LUDLAM AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-2109
Mailing Address - Country:US
Mailing Address - Phone:347-581-5957
Mailing Address - Fax:
Practice Address - Street 1:98 LUDLAM AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-2109
Practice Address - Country:US
Practice Address - Phone:347-581-5957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288633-1164W00000X
NY758041163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse