Basic Information
| Provider Information | |||||||||
| NPI: | 1659728020 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARINO | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | |||||||||
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| Credential: | MA, DRCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 671 HOES LANE W | ||||||||
| Address2: | |||||||||
| City: | PISCATAWAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088558021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322355900 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10 CORPORATE PLACE S | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | PISCATAWAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088546148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322355000 | ||||||||
| FaxNumber: | 7325620109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2016 | ||||||||
| LastUpdateDate: | 05/16/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.