Provider Demographics
NPI:1508120544
Name:BUDRONIS, MARIANNE K (MS,SAS,SDA)
Entity Type:Individual
Prefix:MRS
First Name:MARIANNE
Middle Name:K
Last Name:BUDRONIS
Suffix:
Gender:F
Credentials:MS,SAS,SDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 BELTAGH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-2654
Mailing Address - Country:US
Mailing Address - Phone:516-781-1104
Mailing Address - Fax:
Practice Address - Street 1:2609 BELTAGH AVE
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-2654
Practice Address - Country:US
Practice Address - Phone:516-781-1104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9140174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist