Provider Demographics
NPI:1609867944
Name:MARIANO, ALEJANDRO T (PT)
Entity Type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:T
Last Name:MARIANO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2535 ARTHUR KILL RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-1207
Mailing Address - Country:US
Mailing Address - Phone:718-448-3210
Mailing Address - Fax:718-984-2642
Practice Address - Street 1:65 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4325
Practice Address - Country:US
Practice Address - Phone:718-448-3210
Practice Address - Fax:718-816-7417
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01039512251N0400X, 2251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
S93366Medicare UPIN
NYQ49961Medicare PIN