Basic Information
Provider Information
NPI: 1730199258
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MARANO
FirstName: HENRY
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 635 BELLE TERRE RD
Address2: SUITE #204
City: PORT JEFFERSON
State: NY
PostalCode: 117771935
CountryCode: US
TelephoneNumber: 6314740008
FaxNumber: 6314740224
Practice Location
Address1: 315 MEETING HOUSE LANE
Address2:  
City: SOUTH HAMPTON
State: NY
PostalCode: 11968
CountryCode: US
TelephoneNumber: 6312830355
FaxNumber: 6312832084
Other Information
ProviderEnumerationDate: 08/08/2006
LastUpdateDate: 01/27/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000X171961-1NYY Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 

No ID Information.


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