Provider Demographics
NPI:1053728519
Name:MARIGLIANO, ADAM (LMT)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:MARIGLIANO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4321 220TH PL
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3646
Mailing Address - Country:US
Mailing Address - Phone:917-468-4722
Mailing Address - Fax:718-224-1979
Practice Address - Street 1:4321 220TH PL
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3646
Practice Address - Country:US
Practice Address - Phone:917-468-4722
Practice Address - Fax:718-224-1979
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist