Provider Demographics
NPI:1881179158
Name:MAROTTA, DAWN CHRISTINE
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:CHRISTINE
Last Name:MAROTTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-3308
Mailing Address - Country:US
Mailing Address - Phone:631-258-3136
Mailing Address - Fax:
Practice Address - Street 1:25 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-3308
Practice Address - Country:US
Practice Address - Phone:631-258-3136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency