Provider Demographics
NPI:1710076757
Name:MARINO, CHARLES J (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:MARINO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:91 GLENEIDA AVE
Mailing Address - Street 2:STEA
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-1222
Mailing Address - Country:US
Mailing Address - Phone:845-228-7000
Mailing Address - Fax:845-228-5485
Practice Address - Street 1:91 GLENEIDA AVE
Practice Address - Street 2:STE A
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-1222
Practice Address - Country:US
Practice Address - Phone:845-228-7000
Practice Address - Fax:845-228-5485
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYX008583111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU68906Medicare UPIN
NYX99811Medicare ID - Type Unspecified