Provider Demographics
NPI:1255425237
Name:MARIANO, DANIEL VINCENT
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:VINCENT
Last Name:MARIANO
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 1:60 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-1232
Mailing Address - Country:US
Mailing Address - Phone:201-935-4466
Mailing Address - Fax:201-507-0135
Practice Address - Street 1:60 UNION AVE
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-1232
Practice Address - Country:US
Practice Address - Phone:201-935-4466
Practice Address - Fax:201-507-0135
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00149600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ519575Medicare ID - Type Unspecified
NJT45650Medicare UPIN