Provider Demographics
NPI:1790022556
Name:MANNINO, MARIE LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:LOUISE
Last Name:MANNINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-3331
Mailing Address - Country:US
Mailing Address - Phone:973-423-3534
Mailing Address - Fax:
Practice Address - Street 1:91 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-3331
Practice Address - Country:US
Practice Address - Phone:973-423-3534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-13
Last Update Date:2013-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04197906207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine