Provider Demographics
NPI:1760715007
Name:MARIANO, KATHRYN RAE (FNP)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:RAE
Last Name:MARIANO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247-77A 77TH CRESCENT
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE
Mailing Address - State:NY
Mailing Address - Zip Code:11426-1142
Mailing Address - Country:US
Mailing Address - Phone:516-413-7684
Mailing Address - Fax:
Practice Address - Street 1:184 E 70TH ST
Practice Address - Street 2:OFC 5
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5154
Practice Address - Country:US
Practice Address - Phone:212-535-1550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335716207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology