Provider Demographics
NPI:1710248679
Name:FARRELLY, MARIKO (MS)
Entity Type:Individual
Prefix:MRS
First Name:MARIKO
Middle Name:
Last Name:FARRELLY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-1031
Mailing Address - Country:US
Mailing Address - Phone:914-674-1111
Mailing Address - Fax:
Practice Address - Street 1:104 FOREST BLVD
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-1031
Practice Address - Country:US
Practice Address - Phone:914-674-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist