Provider Demographics
NPI:1780019901
Name:MARINO, JOSEPH A (OPHTHALMIC DISPENSER)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:A
Last Name:MARINO
Suffix:
Gender:M
Credentials:OPHTHALMIC DISPENSER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 TRENT ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-3057
Mailing Address - Country:US
Mailing Address - Phone:646-236-1673
Mailing Address - Fax:718-448-7675
Practice Address - Street 1:11 TRENT ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-3057
Practice Address - Country:US
Practice Address - Phone:646-236-1673
Practice Address - Fax:718-448-7675
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007676156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician