Provider Demographics
NPI:1518954981
Name:MARIANO, ROSALIND SIA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSALIND
Middle Name:SIA
Last Name:MARIANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-1056
Mailing Address - Country:US
Mailing Address - Phone:315-769-4222
Mailing Address - Fax:315-769-4671
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-1056
Practice Address - Country:US
Practice Address - Phone:315-769-4222
Practice Address - Fax:315-769-4671
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135112174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB8019OtherALICE HYDE MEDICAL CENTER
NYD91654Medicare UPIN