Provider Demographics
NPI:1942522677
Name:MARIANO, STEPHANIE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:MARIANO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-2629
Mailing Address - Country:US
Mailing Address - Phone:973-783-0719
Mailing Address - Fax:
Practice Address - Street 1:536 RIDGE RD
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1611
Practice Address - Country:US
Practice Address - Phone:973-239-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01225400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist