Provider Demographics
NPI:1770191454
Name:DIMICELI, MARINA (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:DIMICELI
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 HAWK LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-4918
Mailing Address - Country:US
Mailing Address - Phone:917-562-0152
Mailing Address - Fax:
Practice Address - Street 1:18 HAWK LN
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-4918
Practice Address - Country:US
Practice Address - Phone:917-562-0152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010916225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist