# MARINERS RESIDENCE INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639806490
- **Authorized official:** MR. AVI LUSTIG (OWNER)
- **Authorized official phone:** (917) 544-4713

## Contact information

- **Practice address:** 2099 FOREST AVE, STATEN ISLAND, NY 10303-2239
- **Practice address phone:** (917) 544-4713
- **Mailing address:** 2099 FOREST AVE, STATEN ISLAND, NY 10303-2239
- **Mailing address phone:** (917) 544-4713

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 08/02/2022
- **Last updated:** 08/22/2022