Provider Demographics
NPI:1619978806
Name:MARINO, THOMAS STEPHEN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:STEPHEN
Last Name:MARINO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:5 CHELSEA DR
Mailing Address - Street 2:
Mailing Address - City:NORTH MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-2005
Mailing Address - Country:US
Mailing Address - Phone:516-804-6210
Mailing Address - Fax:
Practice Address - Street 1:123 W 124TH ST
Practice Address - Street 2:HARLEM UNITED COMMUNITY AIDS CENTER
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4920
Practice Address - Country:US
Practice Address - Phone:212-531-1300
Practice Address - Fax:212-531-1085
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY008353363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ31504Medicare UPIN