Provider Demographics
NPI:1689902058
Name:LEONARD N MARINO DC PC
Entity Type:Organization
Organization Name:LEONARD N MARINO DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-816-9000
Mailing Address - Street 1:1292 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301
Mailing Address - Country:US
Mailing Address - Phone:718-816-9000
Mailing Address - Fax:
Practice Address - Street 1:1292 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3904
Practice Address - Country:US
Practice Address - Phone:718-816-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007221261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service