Provider Demographics
NPI:1588005706
Name:FASSINO, MARIANNE T (RN)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:T
Last Name:FASSINO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:472 GLEN DR
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-1128
Mailing Address - Country:US
Mailing Address - Phone:631-830-2510
Mailing Address - Fax:
Practice Address - Street 1:472 GLEN DR
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-1128
Practice Address - Country:US
Practice Address - Phone:631-830-2510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22424986163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation