Basic Information
| Provider Information | |||||||||
| NPI: | 1760714463 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARINELLI | ||||||||
| FirstName: | RAFAEL | ||||||||
| MiddleName: | AARON | ||||||||
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| Credential: | PT, DPT, L.A.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1311 MAMARONECK AVE STE 140 | ||||||||
| Address2: | |||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106055224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888304125 | ||||||||
| FaxNumber: | 2015926401 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 TOWNE CENTER DRIVE | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | CLIFFSIDE PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070102056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019880796 | ||||||||
| FaxNumber: | 2017318581 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2010 | ||||||||
| LastUpdateDate: | 03/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | 25MZ00072400 | NJ | N | Other Service Providers | Acupuncturist | 225100000X | 40QA02080100 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.