Provider Demographics
NPI:1568667210
Name:MAROTTA, ANTONIO VR (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:VR
Last Name:MAROTTA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 ROUTE 146
Mailing Address - Street 2:230
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3662
Mailing Address - Country:US
Mailing Address - Phone:518-357-3347
Mailing Address - Fax:
Practice Address - Street 1:939 ROUTE 146
Practice Address - Street 2:SUITE 230
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3662
Practice Address - Country:US
Practice Address - Phone:518-357-3347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB7409Medicare PIN