Individual
MR. MARINO A POLISENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1050 CLOVE RD, STATEN ISLAND, NY 10301-3627
(718) 442-4300
(718) 816-8369
Mailing address
1050 CLOVE RD, STATEN ISLAND, NY 10301-3627
(646) 680-2888
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
225825
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02590985
—
NY
01
—
0297012
GHI
—
01
—
7166589
AETNA
—
Enumeration date
10/04/2005
Last updated
07/16/2015
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