Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | MARIM1 | NY |
NPI | 1417326885 |
---|---|
Provider Name | Dr. Michelle J Marinello |
First Address | Buffalo, NY 14202-1304 |
Second Address | Buffalo, NY 14202-1304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2015 |
Last Update Date | 16/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MARIM1 | CERTIFICATE OF QUALIFICATION (01) | NY |