Provider Demographics
NPI:1851362677
Name:MARISKI, STEPHEN C (PT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:C
Last Name:MARISKI
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 1:427 BROADWAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-1742
Mailing Address - Country:US
Mailing Address - Phone:845-796-2470
Mailing Address - Fax:
Practice Address - Street 1:427 BROADWAY
Practice Address - Street 2:SUITE 3
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1742
Practice Address - Country:US
Practice Address - Phone:845-796-2470
Practice Address - Fax:845-796-1420
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008334-1225100000X
CT002518225100000X
NJQA02200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ35821Medicare ID - Type Unspecified