Provider Demographics
NPI:1790736015
Name:MARAIS, DENIS (PT)
Entity Type:Individual
Prefix:MR
First Name:DENIS
Middle Name:
Last Name:MARAIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 RONALDS LN
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-7517
Mailing Address - Country:US
Mailing Address - Phone:914-813-2267
Mailing Address - Fax:914-834-5402
Practice Address - Street 1:1420 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-3922
Practice Address - Country:US
Practice Address - Phone:914-834-5490
Practice Address - Fax:914-834-5402
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021126225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ01B71Medicare ID - Type Unspecified