Basic Information
Provider Information | |||||||||
NPI: | 1184982779 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MARINO | ||||||||
FirstName: | MARTIN | ||||||||
MiddleName: | J | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: | JR. | ||||||||
Credential: | RN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MARINO | ||||||||
OtherFirstName: | MARTIN | ||||||||
OtherMiddleName: | J | ||||||||
OtherNamePrefix: | MR. | ||||||||
OtherNameSuffix: | JR. | ||||||||
OtherCredential: | RN | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 1945 HWY 33 | ||||||||
Address2: | CRISIS UNIT | ||||||||
City: | NEPTUNE | ||||||||
State: | NJ | ||||||||
PostalCode: | 07753 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7327762325 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1945 ROUTE 33 | ||||||||
Address2: | CRISIS UNIT | ||||||||
City: | NEPTUNE | ||||||||
State: | NJ | ||||||||
PostalCode: | 077534859 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7327762325 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/02/2012 | ||||||||
LastUpdateDate: | 05/02/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 26NR13961500 | NJ | Y |   | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.