Provider Demographics
NPI:1760607204
Name:CARINO, MARIEL GAZMEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIEL
Middle Name:GAZMEN
Last Name:CARINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 MEDJAY LN
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755
Mailing Address - Country:US
Mailing Address - Phone:732-608-6203
Mailing Address - Fax:
Practice Address - Street 1:117 SUSQUEHANNA AVE
Practice Address - Street 2:
Practice Address - City:OLYPHANT
Practice Address - State:PA
Practice Address - Zip Code:18447
Practice Address - Country:US
Practice Address - Phone:570-383-0275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 033780 L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE405OtherGEISINGER HEALTH PLAN
TX0005183329OtherAETNA
PACH131675Medicare ID - Type Unspecified
PAE405OtherGEISINGER HEALTH PLAN