Provider Demographics
NPI:1952411936
Name:FARINA, MARYANNE R (PA)
Entity Type:Individual
Prefix:
First Name:MARYANNE
Middle Name:R
Last Name:FARINA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 PATRIOTS RD
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-3318
Mailing Address - Country:US
Mailing Address - Phone:631-444-8608
Mailing Address - Fax:631-444-8778
Practice Address - Street 1:100 PATRIOTS RD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-3318
Practice Address - Country:US
Practice Address - Phone:631-444-8608
Practice Address - Fax:631-444-8778
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT000887363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004187466Medicaid
CTP43806Medicare UPIN
CT004187466Medicaid