Provider Demographics
NPI:1558778449
Name:TONY MAREK INC
Entity Type:Organization
Organization Name:TONY MAREK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ATHLETIC TRAINER
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAREK
Authorized Official - Suffix:
Authorized Official - Credentials:LAT
Authorized Official - Phone:775-530-6892
Mailing Address - Street 1:PO BOX 19281
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-1620
Mailing Address - Country:US
Mailing Address - Phone:775-530-6892
Mailing Address - Fax:
Practice Address - Street 1:3760 BARRON WAY
Practice Address - Street 2:SUITE D
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2388
Practice Address - Country:US
Practice Address - Phone:775-530-6892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-13
Last Update Date:2014-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0506007261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center