Individual
MARC ANTHONY MORTELLARO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
622 W 168TH ST PH 11, NEW YORK, NY 10032-3720
(212) 305-6445
(212) 305-4040
Mailing address
622 W 168TH ST PH 11, NEW YORK, NY 10032-3720
(212) 305-6445
(212) 305-4040
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
001899
NY
Other
Enumeration date
05/02/2018
Last updated
05/02/2018
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