Provider Demographics
NPI:1669650586
Name:MARINO, LORI (PA)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:MARINO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-3026
Mailing Address - Country:US
Mailing Address - Phone:973-622-3900
Mailing Address - Fax:973-622-1698
Practice Address - Street 1:151 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-3026
Practice Address - Country:US
Practice Address - Phone:973-622-3900
Practice Address - Fax:973-622-1698
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00179800363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant