Provider Demographics
NPI:1881852069
Name:SORIANO, MARLON
Entity Type:Individual
Prefix:
First Name:MARLON
Middle Name:
Last Name:SORIANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8714 63RD DR
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4826
Mailing Address - Country:US
Mailing Address - Phone:646-462-0248
Mailing Address - Fax:
Practice Address - Street 1:14454 SANFORD AVE
Practice Address - Street 2:APT 18
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-1680
Practice Address - Country:US
Practice Address - Phone:718-709-8316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-24
Last Update Date:2012-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025942-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist