Provider Demographics
NPI:1659728020
Name:MARINO, NICHOLAS (MA, DRCC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:MARINO
Suffix:
Gender:M
Credentials:MA, DRCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 HOES LANE W
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08855-8021
Mailing Address - Country:US
Mailing Address - Phone:732-235-5900
Mailing Address - Fax:
Practice Address - Street 1:10 CORPORATE PLACE S
Practice Address - Street 2:SUITE 205
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-6148
Practice Address - Country:US
Practice Address - Phone:732-235-5000
Practice Address - Fax:732-562-0109
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator