Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 0103951 | NY |
N | 2251N0400X | Physical Therapist - Neurology | 0103951 | NY |
N | 2251X0800X | Physical Therapist - Orthopedic | 0103951 | NY |
NPI | 1609867944 |
---|---|
Provider Name | Alejandro T Mariano |
First Address | Staten Island, NY 10309-1207 |
Second Address | Staten Island, NY 10304-4325 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2005 |
Last Update Date | 25/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S93366 | (02) |