Provider Demographics
NPI:1558344614
Name:MARINO, JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:MARINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 W 50TH ST
Mailing Address - Street 2:6 GG
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-6664
Mailing Address - Country:US
Mailing Address - Phone:917-952-3610
Mailing Address - Fax:212-459-2850
Practice Address - Street 1:350 W 50TH ST
Practice Address - Street 2:#6 GG
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-6664
Practice Address - Country:US
Practice Address - Phone:917-952-3610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154932101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02321497Medicaid
NYF44878Medicare UPIN
NY576T01Medicare ID - Type UnspecifiedEMPIRE