Individual
JEAN MARINO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
225 BROADHOLLOW RD STE 402, MELVILLE, NY 11747-4899
(631) 332-9752
Mailing address
PO BOX 970, EAST NORTHPORT, NY 11731-0534
(631) 332-9752
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
11/30/2018
Last updated
11/30/2018
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