Provider Demographics
NPI:1760714463
Name:MARINELLI, RAFAEL AARON (PT, DPT, LAC)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:AARON
Last Name:MARINELLI
Suffix:
Gender:M
Credentials:PT, DPT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 MAMARONECK AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-5224
Mailing Address - Country:US
Mailing Address - Phone:888-830-4125
Mailing Address - Fax:201-592-6401
Practice Address - Street 1:1 TOWNE CENTER DRIVE
Practice Address - Street 2:SUITE 107
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-2056
Practice Address - Country:US
Practice Address - Phone:201-988-0796
Practice Address - Fax:201-731-8581
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00072400171100000X
NJ40QA02080100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist