Provider Demographics
NPI:1508149782
Name:MARINIS, THOMAS (RN)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:MARINIS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 WEST IU WILLETS RD.
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1308
Mailing Address - Country:US
Mailing Address - Phone:516-510-5185
Mailing Address - Fax:
Practice Address - Street 1:60 I.U. WILLETS RD.
Practice Address - Street 2:
Practice Address - City:ALBERTSON
Practice Address - State:NY
Practice Address - Zip Code:11507-1308
Practice Address - Country:US
Practice Address - Phone:516-877-2862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22528640163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse